The Director of UM and Physician Review Services is responsible for assisting in the development and implementation of operational and functional support for the Medical/Behavioral UM and Physician Review Service Departments inclusive of prospective, level of care, retrospective, referral management, triage, and UM services in all locations.
The Director directs and coordinates the operations of the Medical/Behavioral Health UM and Physician Review Service Departments to ensure compliance with product development, policy and procedures and regulatory standards.
This position assists in ensuring that all regulatory requirements are implemented and in compliance. The Director will assist in working with the appropriate departments in support of development of product collateral, development of presentations and product launches.
Licensed healthcare professional (RN, LCSW, LMHC, LMFT, or PsyD) with current, unrestricted license to practice as a health professional in a state or territory of the United States required. Additional certification in specialty fields or other advanced certification is desirable.
- Bachelor’s degreepreferred in a health science.
- Two years experience in utilization management, quality management and /or discharge planning and/or a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review preferred. Two years experience with application of criteria systems and programs (i.e., InterQual and/or Medical and Behavioral Health criteria sets) preferred.
- Two years experience as a supervisor or other management experiencepreferred. Three or more years of direct care experiencepreferred. Experience in inpatient unit or outpatient program management preferred. Five or more year’s post-Master’s level of direct care experiencerequired. Five or more years in inpatient unit or outpatient program management preferred.
- Call center knowledge desirable
- Ability to conceptualize new product ideas;
- Ability to develop and execute product plans, including identification of resources and budgetrequired;
- Analysis of the effectiveness of products and product components;
- Excellent communication skills, both verbal and written;
- Ability to direct and coordinate product development activities across multiple company functions;
- Strong administrative qualities to report progress and make recommendations for changes;
- Knowledge of managed care, utilization management and physician review service management;
- Computer literate with skills in MSWindows, Excel, Access, utilization/physician review services data bases, or similar programs;
- Knowledge of managed care, utilization management and physician review services program planning, design and implementation.