Newport Healthcare is a series of evidence-based healing centers for adolescents and families struggling with mental health issues. With locations across the United States, Newport Healthcare offers a family-systems approach, providing gender-specific, individualized, and comprehensive holistic programs that encompass clinical therapy, academic support, and experiential practices. We treat individuals, ages 12–18, who are experiencing depression, anxiety, eating disorders, trauma, and substance abuse. Offerings include residential treatment, intensive outpatient programming, therapeutic day schools, and day treatment. Newport Healthcare nurtures the physical, psychological, social, educational, and spiritual needs of adolescents and their families, from a foundation of compassionate care, clinical expertise, and unconditional love. Our primary mission is to empower teens and restore families. Experts include medical directors, psychiatrists, therapists, registered dietitians, nurses, licensed social workers, teachers, and more.
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Under Executive Management direction plan, organize, and manage day-to-day Utilization Review (UR) Department operations, supervise the UR staff, and perform the related duties as required. Primarily responsible for ensuring that every client of Newport Academy is authorized by insurance at the appropriate level of coverage, as applicable.
Essential Director of Utilization Review Responsibilities:
- Oversee daily operations and scheduling of the Utilization Review Department.
- Collaborate with the Clinical Team, families, Admissions leadership, and Executive Management to determine coverage, length of stay, and financial responsibility.
- Monitor and track employee progress, providing regular assessments and feedback.
- Act as a liaison between UR Staff, the Treatment Team, the Business Office, and families to communicate both authorization levels and financial status.
- Implement documentation systems to ensure charting meets compliance standards and effectively supports rationales for continued stay.
- Implement UR and documentation trainings for all staff nationwide and conduct trainings on an ongoing basis.
- Utilize clinical information and knowledge of Behavioral Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and health care partners.
- Hiring and training of all new UR personnel.
- Collaborate in Continuing Care planning to ensure timely discharge, optimal benefit, and financial utilization, as well as compliance with industry discharge standards.
- Daily collaboration with Admissions Director, Associate Director, and Managers to ensure timely Admissions.
- Utilize knowledge of specific polices to estimate length of stay, reimbursement rates, and financial implications.
- Establish and maintain direct relationships with families, the Treatment Team, Admissions, the Business Office, and direct-care staff.
- Prepare and submit appeals documentation to the appropriate entities as indicated.
- As needed, conduct assessments and interviews with clients and/or families for the purpose of clinical clearance and/or insurance authorization.
- Collect, track, and report metrics.
- May be asked to perform additional tasks by Vice President of Admissions.
Education and Experience:
- Five years of experience in Behavioral Healthcare (required)
- Two years of management experience (required)
- Medical or Clinical License (preferred)
- Five years of experience in Behavioral Healthcare Utilization Review (preferred)
Newport Academy is an Equal Opportunity Employer