Utilization Review Director

Job Description

Responsibilities

Three Rivers Behavioral Health is a -bed treatment facility that specializes in quality behavioral health and substance abuse services for adolescents and adults. We offer a full continuum of care through an integrated system of inpatient, partial hospitalization and intensive outpatient programs. Conveniently located between I- (Exit ) and I- (Exit ) in West Columbia, SC, our team of + high quality employees describe working here as " family atmosphere," "supportive leadership," and "life-changing." Progressive professionals in the fields of psychiatry, medicine, nursing, social services, and activity therapy serve hundreds of adults and adolescents each month with the common goal of creating new beginnings. Healthcare professionals have a unique opportunity to affect lives for the better each and every day. Choose Three Rivers and start your life-changing journey today.

JOB SUMMARY: The Director is responsible for the management of the Utilization Review Department and the collection, aggregation, analysis, and reporting of complex clinical data. Will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services.

KEY RESPONSIBILITIES:

Manages the review of medical records to determine the appropriateness of admissions, procedures, and the necessity of continued hospital stay, based on Centers for Medicare and Medicaid Services (CMS) guidelines.
Performs continuing review of the medical record, identifying the need for on-going hospitalization through the evaluation of clinical data documented in laboratory reports, radiology reports, and multidisciplinary progress notes. Identifies and certifies for billing and hospital utilization/case management purposes, the acute hospital length of stay authorized for each case.
Performs medical record reviews interpreting, abstracting, aggregating, analyzing and reporting complex clinical data obtained from medical records.

BENEFITS:

Career development opportunities across UHS and our + locations!
Diverse programming to expand your experience
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
Employee Assistance Program
(K) with company match and discounted stock plan
Pet Insurance
SoFi Student Loan Refinancing Program
Tuition Assistance
Employee Referral Program
More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

Qualifications

Job Requirements

Masters’ degree in a recognized mental health field or Registered Nurse

Minimum of two years psychiatric experience in chart analysis and in the utilization review field. One (1) year of management experience preferred.

Current RN license, LPC or LMSW preferred.