What are the responsibilities and job description for the Director of Utilization Review position at UHS?
Position Summary: |
Oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement. |
Minimum Qualifications: | |
Masters prepared healthcare leader/director (Nursing, Counseling, Psychology or Social Work). | Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation. |
A minimum of 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders. | Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines. |
Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations. | Excellent oral and written communication skills that drive departmental hospital engagement. |
Qualifications
Essential Requirements/ Job Specific Standards |
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. |
Directs utilization management staff and performs all administrative department head functions. |