Director of Utilization Management/Review

UHS • $90K — $120K *
Hopkinsville, KY 42240In-Person
Healthcare
Less than 5 years of experience
2 weeks ago
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Nursing or related field, Master's preferred.
  • Minimum 3 years working in an acute inpatient psychiatric setting.
  • 3-5 years experience in utilization management for mental health and substance abuse disorders.
  • Strong understanding of regulatory compliance and documentation requirements.
  • Experience leading and managing teams effectively.

Responsibilities

  • Oversee all utilization management functions.
  • Facilitate precertification, concurrent, and discharge reviews.
  • Ensure regulatory compliance with proper documentation.
  • Serve as a member of the hospital management team.
  • Conduct payer engagement and oversight of audits.
  • Lead the Utilization Management committee and activities.
  • Manage staff and administrative duties within the department.

Benefits

  • Challenging and rewarding work environment.
  • Competitive compensation and generous paid time off.
  • Excellent medical, dental, vision, and prescription plans.
  • 401(k) with company match and discounted stock plans.
  • SoFi Student Loan Refinancing Program.
  • Retention bonus program.
  • Career development opportunities across 300+ UHS subsidiaries.
Full Job Description
Responsibilities

Director of Utilization Review Management Opportunity

Cumberland Hall Hospital is a 97 bed, licensed, acute psychiatric hospital located in beautiful Hopkinsville, KY. Cumberland Hall features individual units for youth, adults and active-duty military, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 1500 patients receive care from our compassionate health care team each year at Cumberland Hall Hospital.

Website: https://cumberlandhallhospital.com/

Job Duties to include:
  • 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.
  • Manages utilization management staff and performs all administrative department head functions.

This role will also be responsible for their own case-management load, while supporting and supervising the Utilization Review team.

As a senior leader, the Director of Utilization Management is a working director participating as an administrator on call and working evenings and weekends as required to support the team.

Benefits for staff include:

  • Challenging and rewarding work environment
  • Competitive Compensation and 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
  • Retention Bonus Program
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com

Qualifications

Director of Utilization Review Management Requirements:

  • Education: Bachelor's Degree from an accredited college or university in Nursing, Master's Degree from an accredited college or university in nursing, social work, mental health, or related field preferred.
  • Experience: A minimum of 3 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.

About UHS

UHS Careers

Joining UHS presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to making a difference. UHS, known for its commitment to innovation and leadership in the healthcare sector, offers a variety of job opportunities that cater to a diverse range of skills and experiences.

Explore Job Opportunities

UHS is actively hiring and offers a wide array of positions, from clinical roles to administrative support. Each position at UHS is designed to challenge team members while providing meaningful service to the community. Explore the current job openings and find a career path that suits professional aspirations and skills.

Internship Programs

UHS provides robust internship programs that offer hands-on experience in the healthcare industry. Internships are a cornerstone of professional development, giving participants a chance to deepen practical skills in a real-world setting. These programs are tailored to foster growth and prepare interns for a full-time position within the company.

Professional Growth and Development

UHS believes in nurturing the career growth of its team members through comprehensive professional development programs. These include leadership training, diversity training, and continuous education in the latest healthcare practices, ensuring that every team member has the opportunity to advance their career.

Benefits and Culture

Employment at UHS comes with competitive benefits designed to support the health, well-being, and financial security of each team member and their families. The company culture at UHS is built on a foundation of respect and inclusion, where diversity is celebrated and every voice is heard.

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Hospitals & Medical Centers
* Ladders Estimates

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