Director of Utilization Management

1 month ago

Canton, United States Sunrise Vista Full time
Director Utilization Management

Who we are

The NewVista mission is to inspire hope and deliver holistic care to those in need of behavioral health services in a contemporary and healing environment - one that is conducive to providing the life skills needed to regain stability and independence, utilizing a passionate and highly trained team of professionals. With a blend of group therapy, clinical treatment and unique surroundings, our beautiful healthcare centers provide a safe, healing environment for adults and seniors with a variety of complex needs. We provide a serene environment that promotes medical, rehabilitative and emotional health, and are devoted to promoting greater peace of mind on the journey of hope and healing.

Our team at Sunrise Vista provides professional, compassionate care for adults and seniors in need of behavioral health services in a contemporary and healing environment. Located in Canton, Ohio, our behavioral health hospital specializes in treating symptoms associated with depression, anxiety, acute psychosis and other mental health crises and co-occurring detox needs. Utilizing a blend of group therapy and clinical treatment, our center provides a safe, therapeutic space. Our team our highly trained doctors and clinicians work closely to develop and oversee individualized care plans, with the goal of build the self-reliance and confidence needed for individuals to integrate safely back into the community.

Our compassionate team members work in a challenging yet rewarding environment where each person is a part of making direct impact to our patient's lives. Our team members work with our patients to help in the recovery and treatment process to restore to a better quality life through their individual plans, group therapy and overall stay at our facility.

Perks at Work

Team Members enjoy a variety of perks in working with the NewVista brand company. We offer competitive market wages along with a full robust package around Healthcare, Life Balance, Education, Leadership Development and Recognition.

Healthcare + Life Balance:
  • Medical Packages with Rx - 3 Choices
  • Flexible Spending Accounts (FSA)
  • Dependent Day Care Spending Accounts
  • Health Spending Accounts (HSA) with a company match
  • Dental Care Program - 2 choices
  • Vision Plan
  • Life Insurance Options
  • Accidental Insurances
  • Paid Time Off + Paid Holidays
  • Employee Assistance Programs
  • 401k with a Company Match
Education + Leadership Development
  • Up to $15,000 in Tuition Reimbursements OR Student Loan forgiveness
  • Mentoring + Trainer Opportunities through our Horizon Mentorship Program
  • Growth in Director and CEO positions through our Horizon Leadership Program
  • Handle with Care Trainer - Certifications
Recognition + Rewards
  • On the spot recognition Prizes
  • Team Member of the Quarter
  • Team Member of the Year
  • Monthly Celebrations
  • Team Member Recognition Cards
The Role Itself

Sunrise is currently seeking experienced Director of Utilization Management to work in a therapeutic hospital setting providing utilization management for inpatient and outpatient services.

The Director of Utilization Management is responsible for the oversight of the Utilization Management Department for Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeal. The UM Director will ensure an appropriate discharge plan is in place for each patient discharge. The UM Director will accurately report the authorization status of patients, denials and appeals status to the CEO, CFO, and Business Office staff. The Director will ensure all UM staff follow department and facility procedures and ensure effective communication with all relevant departments regarding patient care needs.

Job responsibilities include:
  • Oversees the request for services including the determination of appropriate level of care, initial authorization, the concurrent review process and appropriate discharge planning.
  • Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
  • Participates in clinical team review and evaluation of services offered at the facility to ensure goals and objectives are consistent throughout programs and facility expectations.
  • Meets regularly with program managers, physicians, clinical staff and the Medical Director to ensure compliance with program goals and objectives.
  • Works alongside the DON, the Director of Clinical Services and other leadership in the development of the treatment team agenda while educating the team member of the UM role for same.
  • Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Oversees continuity of care for each level of care transition.
  • Oversees the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Documents and updates the denial log to reflect same.
  • Maintains logs of all certifications and denials along with updated status of same.
  • Develops and maintains processes to minimize denials and communication of same to the CFO and Business Office Manager.
  • Reviews benefit verifications and updates for level of care benefits with the Business Office to ensure and optimize maximum patient care and treatment.
  • Ensures processes are followed to provide adequate continuity of care and communication to families/support systems as well as referral sources for treatment and aftercare planning.
  • Reports results of daily treatment team meetings all discharges and status of high risk cases such as limited benefits, peer reviews, denials or unplanned discharges.
  • Provides education to other UM/other departments/leadership on documentation requirements and criteria to assist with ensuring accurate information and follow through for treatment planning and insurance reviews.
  • Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
  • Ability to state local laws, ordinances, and practices governing involuntary hospitalization and ensure compliance with same.
  • Ensures that hiring, disciplinary actions and termination procedures are in accordance with hospital policies.
  • Ensures adequate orientation for new employees of the UM Department while providing ongoing educational needs and professional development of staff.
  • Facilitates UM team meetings no less than quarterly, or as set by the CEO, with a set agenda for education and training.
  • As necessary, participates in Administrator on Call rotation.
  • Demonstrates an ability to be flexible, organized and function well in stressful situations.
  • Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary.
  • Maintains a good working relationship/team work both within the department and with other departments.
  • Ensures that documentation meets current standards and policies.
  • Manages and operates equipment safely and correctly.
  • Supports and maintains a culture of safety and quality.
  • Demonstrates understanding of HIPAA.
  • Demonstrates understanding of Patient Rights and
  • Patient's Right to Report and Patient AdvocacyOther duties as assigned.
Job Requirements:

Education:
  • Bachelor's Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field required; Master's Degree preferred.
Work Experience:
  • Direct clinical experience in a psychiatric or mental health treatment setting, including managing a related function preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
Other Requirements
  • Positive Attitude
  • Critical thinking skills, decisive judgment and the ability to work with minimal supervision.
  • Must be able to work in a stressful environment and take appropriate action.
  • Teamwork, flexibility needed to fulfill job responsibilities, adapting to changes in work environment and accepting supervisory feedback.


Qualified candidates, please apply now for a chance to join an outstanding team.

Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.

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