DIR - UTILIZATION REVIEW / MGMT

Riveredge Hospital is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare professionals!

Position Summary:

The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient and Partial Hospital services. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, overseeing the response to requests for services and interfaces with managed care organizations, external reviewers and other payers.

Duties include, but are not limited to:

• Direct the response to requests for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.
• Review the effectiveness of the comprehensive interface with external reviewers, communicate with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of the reviews and provide consultation as needed.
• Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
• Establish standards for customer relations and monitor the interactions between Utilization Management staff and customers to evaluate the effectiveness of customer service.
• Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the case management program.
• Participate in clinical team analysis and evaluation of current services offered the facility.
• Ensure strategic program goals and objectives are consistent with the overall organization and facility goals and objectives.
• Develop goals, objectives, policies, and procedures related to the operational needs of the program scenarios.
• Consult with facility management in the development and facilitation of program activities which assure an optimal therapeutic experience for all patients.
• Participate with ensuring that individual patients and their families are involved in the development of individualized treatment plans.
• Develop and maintain a system to minimize and address denials in consult with the facility Business Office Manager and CFO.

Benefit Highlights:

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300 Subsidiaries! * More information is available on our Benefits Guest Website: benefits.uhsguest.com

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. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World's Most Admired Companies by Fortune; listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. 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

Requirements:

• Bachelor's degree in Nursing or Master's degree in Social Work, Mental Health/Behavioral Sciences required. Master's Degree preferred.
• A minimum of 5 years of clinical experience in an inpatient behavioral health hospital required.
• 3 - 5 years of management experience in a related position required.
• Experience with patient assessments, family motivation, treatment planning and communication with external review organizations (i.e. managed care, Medicare, Medicaid) or comparable entities required.
• Knowledge of or experience with patients' rights, advanced directives, adult and child abuse laws and emergency detention required.
• A valid clinical license in the State of Illinois (LCPS,LCSW,or R.N) required.

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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.