Director of Utilization Management

UHS • $90K — $110K *
Danville, VA 24540In-Person
Hospitals & Medical Centers
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in human services; Master's preferred.
  • 3-5 years of experience in utilization review and case management.
  • RN, LCSW, LPC, LMFT, or LCP in Virginia required.
  • Basic understanding of medical terminology and psychiatric disorders.
  • Ability to gather and analyze data.
  • Strong communication skills for interaction with families, payors, and clinical staff.
  • Demonstrated initiative, tact, and good judgment.

Responsibilities

  • Coordinate the development and monitoring of the facility-wide UM program according to standards.
  • Develop systems to address customer concerns and recommend changes for integrity.
  • Review clinical data with third-party reviewers regarding patient care.
  • Communicate and coordinate care decisions from third-party reviewers with staff.
  • Facilitate physician reviews with medical staff and reviewers.
  • Attend daily multidisciplinary treatment team meetings.
  • Coordinate retrospective appeals to third-party payers.
  • Analyze and disseminate utilization data and statistics.

Benefits

  • Home/Work Life Balance
  • Excellent Medical, Dental, Vision, and Prescription Drug plans
  • 401(k) Retirement Plan with company match
  • Generous Paid Time Off
  • Career Development Opportunities within UHS
  • Challenging and Rewarding Work Environment
  • Free meals!
  • Company stock purchase discount
  • Employee Assistance Program
Full Job Description
Responsibilities

The Hughes Center is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare professionals!

The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth's level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.

Visit us online: www.thehughescenter.com

Position Summary:

The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.

Key Accountabilities & Duties:
  • Coordinates the development, implementation and monitoring of facility-wide UM program consistent with third party payors, managed care, Federal, State, and CARF standards.
  • Develops systems to review and respond to concerns expressed by customers. Together with the appropriate Department Head, he/she works to resolve issued to the satisfaction of the customer and facility. The Director of UM recommends changes in order to protect the integrity of our customer commitment pledge.
  • Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
  • Communicate and coordinate third party reviewer's level of care decisions and expectations to appropriate clinical and administrative staff.
  • Facilitate physician reviews with medical staff and third party reviewers.
  • Attend daily multidisciplinary treatment team meetings.
  • Coordinates and makes Retrospective Appeals to third party payers.
  • Complies, analyzes, and disseminates information and statistics relative to UM, including monthly facility utilization data, medical record chart reviews, service utilization, and special surveys.
  • Other duties as assigned.

Benefits: https://benefits.uhsguest.com/
  • Home/Work Life Balance
  • Excellent Medical, Dental, Vision, and Prescription Drug plans
  • 401(k) Retirement Plan with company match
  • Life Insurance
  • Flexible Spending or Health Savings Account
  • Generous Paid Time Off
  • Career Development Opportunities within UHS and its subsidiaries
  • A Challenging and Rewarding Work Environment
  • Free meals!
  • Company stock purchase discount
  • Employee Assistance Program
Qualifications

  • Bachelor's degree in human services; Master's degree in human services preferred.
  • Three to five years of experience in utilization review and case management.
  • RN, LCSW, LPC, LMFT, or LCP in Virginia required.
  • Basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.
  • Must know how to gather and analyze data.
  • Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing.
  • Must demonstrate initiative, tact and good judgement.
  • Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources.
  • Must have basic computer skills.

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.

Networking and Innovation

UHS encourages a culture of innovation where team members are motivated to bring forward ideas that drive improvement and efficiency. Networking within the company is supported through various events and internal platforms, helping team members to connect, share insights, and collaborate on projects.

Applying for a Position

To apply for a position at UHS, candidates should prepare their resume to highlight relevant experience and skills. The interview process at UHS is thorough, aiming to assess not only the professional qualifications but also the alignment with the company’s values and culture. Interested candidates can visit the UHS Careers page to submit an application and learn more about the hiring process.

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* Ladders Estimates

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