Director of Utilization Review

Job Description

Responsibilities

Utilization Review Director Opportunity -

HRI Hospital is seeking a to join our skilled and dedicated team of psychiatric professionals, who provide service excellence to our patients in a range of inpatient and partial programs and services. This is a hour per week, salaried position.

About Us

HRI Hospital is -bed psychiatric facility with adult inpatient services and several partial hospitalization programs. We are part of the largest private mental health system in Massachusetts and can therefore provide competitive salaries, benefits, and opportunities for growth and development. At the same time, the smaller size of our facility allows us to provide personalized attention and training to all our employees. Employees are part of a multi-disciplinary team of dynamic professionals providing high quality care to a diverse inpatient and outpatient group of individuals. We are located in Brookline – right near Boston University and Coolidge Corner – and provide easy access to public transportation and free parking. Employees are our most valued asset and we encourage qualified individuals to apply.

Website:

The Director of Utilization Review is responsible for coordinating needed aspects of in-house treatment (inpatient, partial hospitalization, outpatient, and crisis) to ensure clinically responsible compliance with managed are utilization review expectations and contract performance standards.

Benefit Highlights

• Tuition Reimbursement
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off ( days per year + roll over)
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• (K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its + Subsidiaries!
• More information is available on our Benefits Guest Website:

Responsibilities

• Negotiate full authorization of days through the provision of timely concurrent information that includes patient status, treatment, and anticipated discharge
• Provide clinical information to managed care organizations that recognizes their review style, criteria, performance standards, and needs
• Maintains, as needed, documentation supporting information provided to MCO on patient status
• Coordinates the appeal of clinically denied days with managed care organizations and monitor results
• Consistently communicates with clinical departments, managed care organization’s assessment of patient status, anticipated discharge, and needed action plans.
• Builds collaborative relationships with needed clinical departments
• Proactively identifies patients at risk for denied days and works with treatment teams to minimize appeal risk
• Audits Medicare files by verifying initial medical necessity: certifications of all Medicare admissions, re-certifications of all Medicare inpatients as required. Audits Medicare files for inpatients and partial programs. Prepares analyses of these audits and presents these findings to the CEO and the Quality Management Committee
• Participates in daily morning meetings with the CEO, reporting on admissions, managed care updates, and certifications, along with any associated problems
• Collaboratively work with Business Office to identify and appeal denied days within designated contractual protocols
• Maintain senior management, medical staff, and clinical departments awareness of significant utilization issues and trends via production of written reports describing utilization trends
• Provide utilization information as requested by supervisor, hospital CEO, or other departments in a timely and accurate fashion
• Participate in CQI process and contribute to overall improvement of care delivery
• Maintain Utilization Management files
• Convene Utilization Management Committee on a quarterly basis, develop needed agenda, and ensure completion and filing of minutes
• Act as Administrator-on-call and provide guidance and direction during emergency situations requiring AOC notification

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune corporation. Headquartered in King of Prussia, PA, UHS has , employees. Through its subsidiaries, UHS operates acute care hospitals, behavioral health facilities, outpatient and other facilities in U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

Requirements

• Education: Master’s in psychology, social work or related field OR ADN/BSN & Registered Nurse in Massachusetts
• Experience: 2 years behavioral health utilization review/managment experience required
• License: LCSW, LMHC, or LICSW preferred OR RN