Director of Utilization Management (UM) / Utilization Review (UR)

Job Title

Oversee 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.

Duties and responsibilities, to include; but are not limited to:

• 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.

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. 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.

Benefit Highlights

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plan
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its 300+ Subsidiaries
• Free Basic Life Insurance
• Tuition Reimbursement
• Student Loan Repayment Program (for some degrees/restrictions apply)
• SoFi Student Loan Refinancing Program

Qualifications

• Bachelor's Degree in Nursing or Master's Degree in Psychology or Social required.
• Valid license in the State of MI as a fully licensed Social Worker, Marriage and Family Therapist, Professional Counselor (i.e. LMSW, LMFT, LPC, LP), or Registered Nurse
• 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.

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.