Director of Utilization Management/Review

2 weeks ago

Hopkinsville, United States UHS Full time
Responsibilities

Cumberland Hall is looking for looking for a Director of Utilization Management/Review

Cumberland Hall Hospital is a 97 bed, licensed, acute psychiatric hospital located in beautiful Hopkinsville, KY. Cumberland Hall features individual units for youth, adults and active duty military, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average over 1500 patients receive care from our compassionate health care team each year at Cumberland Hall Hospital.

To learn more about Cumberland Hall Hospital visit cumberlandhallhospital.com

Job duties to include:

Oversees all utilization management functions. Oversees precertification, concurrent, and discharge utilization reviews. Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources. Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results. Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements.

Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight. Oversees the Utilization Management committee structure. Develops and monitors utilization management plans. Manages utilization management staff and performs all administrative department head functions.

This role will be also be responsible for their own case-management load, while supporting and supervising the Utilization Review team.

As a senior leader, the Director of Utilization Management is a working director participating as an administrator on call and working evenings and weekends as required to support the team.

The Director of Utilization Management reports directly to the hospital's CEO.

Benefits for staff include:
  • Challenging and rewarding work environment
  • Career development opportunities within UHS and its 300+ Subsidiaries
  • Competitive Compensation and Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(k) with company match and discounted stock plan
  • Student Loan Repayment Program Up to $15,000
  • Tuition Reimbursement
  • Free meals on site
To learn more about benefits, please visit: benefits.uhsguest.com.

Qualifications

Education: Master's prepared from an accredited college or university. Previous experience in Mental Health related field preferred. Ph.D. or Master's degree from an accredited college or university in nursing, social work, psychology, mental health or a related field.

Experience: A minimum of 5-7 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.

Additional Preferences:

  • Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations.
  • Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.
  • Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines.
  • Excellent oral and written communication skills that drive departmental hospital engagement.
About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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