Responsibilities
The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient, Partial Hospital, Intensive Outpatient, ECT (River Point) services for Wekiva Springs Center and River Point Behavioral Health. 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.
Conduct department meetings on a regular basis.
Work with clinical leadership to ensure interdisciplinary treatment planning is organized with participation of all appropriate clinical disciplines.
Provide education on the UM plan, documentation requirements, and medical necessity criteria.
Coordinate the collection of outcome data with the company deadline
Ensure that a system is developed to provide continuity of care and communication with family and appropriate referral sources, and ensure the system is evaluated and reviewed regularly.
Report denials to the CEO & CFO daily.
Ensure the department meets Joint Commission, Medicare, federal and state regulatory requirements.
Develop and implement a Performance Improvement tracking system, evaluate the results monthly, and report them to the Performance Improvement Committee in a timely manner.
Ensure all deficiencies identified through the performance improvement analysis are address with appropriate problem solving actions.
Qualifications
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
