DIR - UTILIZATION REVIEW / MGMT

Lighthouse Care Center of Augusta; Augusta (GA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Referral bonus

Competitive pay & generous PTO

Excellent medical, dental, vision, and

Prescription drug plans

401(k) with company match

Career development opportunities

Benefits guest website

Job summary

Lighthouse Care Center of Augusta seeks a dedicated Director of Utilization Review to lead the UR team and align clinical data with insurer requirements. This role focuses on coordinating patient-centric care while ensuring timely authorizations and adherence to regulatory standards.

Located in Augusta, GA, the facility provides psychiatric services with an 84-bed capacity, employing a seasoned clinical team. UHS affiliation adds comprehensive benefits and growth opportunities.

Qualifications

• Master's degree in nursing, social work, mental health counseling, or related field.
• Minimum five years direct clinical experience in a psychiatric or mental health setting.
• Experience in patient assessment, treatment planning and communication with external review organizations.
• Licensure as RN, APRN, APC, LPC, LMSW, or LCSW preferred.

Responsibilities

• Working manager who oversees the Utilization Review coordinators.
• Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff.
• Authorizing entities to ensure initial precertification and continued authorization is achieved.
• Responsible for timely gathering of clinical criteria, communication of criteria, and entry into Midas.

Skills

Utilization Review

Team leadership

Clinical coordination

Education

Master's degree in nursing/social work/mental health counseling

RN/APRN/APC/LMSW/LCSW licensure preferred

Tools

Midas

Job description

Responsibilities

Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Director of Utilization Review to add to our growing team. Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15-years. Located in Augusta, GA our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.

Website: https://www.LighthouseCareCenters.com

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical content; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing and accreditation requirements. The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with treatment services. The population served are patients' whose lives are disrupted or complicated by mental illness, behavioral disturbance, substance issues or inability to function or maintain in the community.

Job Duties/Responsibilities

• Working manager who oversees the Utilization Review coordinators
• Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff
• Authorizing entities to ensure initial precertification and continued authorization is achieved
• Responsible for aspects relative to timely gathering clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems (Midas)

Benefit Highlights

• Referral Bonus Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities.

Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

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Qualifications

Education and Experience

• Masters Degree in nursing, social work, mental health counseling, or related field
• Minimum of five (5) years direct clinical experience in a psychiatric or mental health treatment setting
• Including one year of managing a related function preferred
• Experience in patient assessment, treatment planning and communication with external review organizations or comparable entities

Certifications, License, Registration

Licensure as RN, APRN, APC, LPC, LMSW, LCSW preferred

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.