Bradford Health Services

Medical Director

• Provide leadership and supervision to therapists, counselors, and BHTs, ensuring clinical excellence and adherence to treatment protocols.
• Develop and implement clinical programming, ensuring alignment with state and federal regulations, industry standards, and organizational goals.
• Oversee admissions, discharges, and extensions of treatment, ensuring decisions align with patient needs and clinical best practices.
• Ensure all treatment schedules, staff schedules, and group therapy offerings are maintained and delivered effectively.
• Conduct staff meetings, case reviews, and clinical supervision to support professional development and ensure high standards of patient care.
• Provide direct clinical supervision to therapists and counselors working toward licensure.
• Monitor staff performance and provide feedback, coaching, and corrective actions as necessary.
• Ensure compliance with HIPAA, state and federal regulations, and accreditation requirements.

Clinical Director

Director

• Provide regional operational leadership for Utilization Management across assigned facilities.
• Directly supervise Utilization Review Managers.
• Establish accountability for quality, productivity, timeliness, and financial performance.
• Ensure consistent implementation of enterprise Utilization Management standards.
• Monitor staffing levels and workload distribution to optimize productivity and patient outcomes.
• Oversee initial authorization and concurrent review activities.
• Ensure timely submission of clinical documentation to payers.
• Monitor authorization status to minimize interruptions in patient care.
• Collaborate with clinical teams to maximize medically appropriate authorized days.
• Escalate complex authorization issues as appropriate.
• Promote accurate and complete clinical documentation supporting medical necessity.
• Partner with physicians and clinical leadership to improve documentation quality.
• Monitor trends related to authorization denials and documentation deficiencies.
• Collaborate with clinical teams to improve documentation practices.
• Oversee appeal strategy for medical necessity denials.
• Support peer-to-peer review processes.
• Identify payer trends and develop regional action plans.
• Build collaborative relationships with payer representatives.
• Participate in payer meetings and operational reviews.
• Monitor regional performance metrics including: Authorization approval rate Initial authorization timeliness Continued stay (concurrent review) approval rate Medical necessity denial rate Appeal overturn rate Average approved Length of Stay Revenue at Risk Productivity Quality audit scores Develop corrective action plans when performance targets are not achieved.

Regional Director – Utilization Management

General

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services.
• Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details.
• Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements.
• Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards.
• Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes.

Utilization Review Specialist

Accounts Receivable

• Perform follow-up on aged accounts receivable to ensure timely resolution of balances
• Review and analyze payer denials, identify trends, and take corrective action as needed
• Conduct thorough reviews of patient accounts during the follow-up process to ensure accuracy and completeness of billing
• Submit accurate and complete claims to insurance companies within one (1) business day of creation
• Track and follow up on outstanding claims within 14 days of submission and at regular intervals thereafter until resolution
• Communicate with patients regarding outstanding balances and establish payment arrangements when appropriate
• Follow up on patient account balances within 30 days of statement mailing and regularly thereafter until resolution
• Maintain accurate and up-to-date collection notes in the electronic system in compliance with organizational policies
• Provide regular updates to the Revenue Cycle Operations Manager and other stakeholders regarding account activity and escalations
• Serve as a professional point of contact for internal and external stakeholders, including insurance companies, patients, and third-party vendors
• Escalate unresolved or complex issues to the appropriate supervisor in a timely manner
• Adhere to the provisions of 42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records) and 45 CFR (HIPAA)
• Ensure all credit information and patient account details remain confidential
• Provide courteous and professional assistance to patients, families, and payer representatives
• Foster positive working relationships with colleagues, managers, and external contacts
• Review and recommend accounts for outside collection when necessary
• Participate in training and professional development activities as required
• Perform other duties as assigned to support the team and organizational goals

Accounts Receivable Collector – Insurance Follow Up

Therapist

• Conducting intakes and comprehensive assessments
• Facilitating group therapy and individual counseling sessions
• Case management and treatment planning
• Providing psychoeducation
• Leading family sessions when appropriate
• Collaborating with multidisciplinary treatment providers