Director Utilization Management
Who we are
The NewVista mission is to inspire hope and deliver holistic care to those in need of behavioral health services in a contemporary and healing environment – one that is conducive to providing the life skills needed to regain stability and independence, utilizing a passionate and highly trained team of professionals. Our behavioral health hospital specializes in treating symptoms associated with depression, anxiety, acute psychosis and other mental health crises and co-occurring detox needs. Utilizing a blend of group therapy and clinical treatment, our center provides a safe, therapeutic space.
Perks at Work
- Competitive market wages
- Medical Packages with Rx – 3 Choices
- Flexible Spending Accounts (FSA)
- Dependent Day Care Spending Accounts
- Health Spending Accounts (HSA) with a company match
- Dental Care Program – 2 choices
- Vision Plan
- Life Insurance Options
- Accidental Insurances
- Paid Time Off + Paid Holidays
- Employee Assistance Programs
- 401k with a Company Match
- Up to $15,000 in Tuition Reimbursements OR Student Loan forgiveness
- Mentoring + Trainer Opportunities through our Horizon Mentorship Program
- Growth in Director and CEO positions through our Horizon Leadership Program
- Handle with Care Trainer – Certifications
- On the spot recognition Prizes
- Team Member of the Quarter
- Team Member of the Year
- Monthly Celebrations
- Team Member Recognition Cards
The Role Itself
Sunrise is currently seeking an experienced Director of Utilization Management to work in a therapeutic hospital setting providing utilization management for inpatient and outpatient services.
The Director of Utilization Management is responsible for the oversight of the Utilization Management Department for Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeals. The UM Director will ensure an appropriate discharge plan is in place for each patient discharge and accurately report the authorization status of patients, denials, and appeals status to the CEO, CFO, and Business Office staff.
Job responsibilities include:
- Oversees the request for services including the determination of appropriate level of care, initial authorization, the concurrent review process and appropriate discharge planning.
- Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
- Participates in clinical team review and evaluation of services offered at the facility.
- Meets regularly with program managers, physicians, clinical staff and the Medical Director to ensure compliance with program goals and objectives.
- Works alongside the DON, the Director of Clinical Services and other leadership in the development of the treatment team agenda.
- Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care.
- Oversees coordination with managed care companies regarding peer reviews, retrospective reviews and appeals.
- Maintains logs of all certifications and denials along with updated status of same.
- Develops and maintains processes to minimize denials.
- Reviews benefit verifications and updates for level of care benefits with the Business Office.
- Ensures processes are followed to provide adequate continuity of care and communication to families/support systems.
- Reports results of daily treatment team meetings and status of high-risk cases.
- Provides education to other UM/other departments on documentation requirements.
- Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid).
- Ability to state local laws, ordinances, and practices governing involuntary hospitalization.
- Ensures that hiring, disciplinary actions and termination procedures are in accordance with hospital policies.
- Ensures adequate orientation for new employees of the UM Department.
- Facilitates UM team meetings no less than quarterly.
- Demonstrates an ability to be flexible, organized and function well in stressful situations.
- Interacts professionally with patient/family.
- Maintains a good working relationship with other departments.
- Ensures that documentation meets current standards and policies.
- Supports and maintains a culture of safety and quality.
- Demonstrates understanding of HIPAA and Patient Rights.
- Other duties as assigned.
Job Requirements:
Education:
- Bachelor’s Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field required; Master’s Degree preferred.
Work Experience:
- Direct clinical experience in a psychiatric or mental health treatment setting, including managing a related function preferred.
Other Requirements
- Positive Attitude!
- Critical thinking skills, decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a stressful environment and take appropriate action.
- Teamwork, flexibility needed to fulfill job responsibilities.
Qualified candidates, please apply now for a chance to join an outstanding team.
Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.
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