DIR - UTILIZATION REVIEW / MGMT

Lighthouse-Care-Center-of-August

Westwood (GA)

On-site

USD 100,000 - 150,000

Full time

13 days ago

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Benefits offered by this job

Referral bonus

Challenging environment

Generous PTO

Medical, dental, vision plans

401(k) with company match

Career development

Job summary

Lighthouse Care Center of Augusta seeks a dedicated Director of Utilization Review to lead the UR team and ensure efficient, compliant authorizations for psychiatric care. This role integrates clinical data with insurance requirements to support high-quality, cost-effective treatment.

The candidate will oversee UR coordinators, coordinate with physicians and therapists, and manage pre-certifications while ensuring accurate data entry and reporting to payers.

Qualifications

Master's degree in nursing or related field.
5+ years psychiatric/mental health clinical experience.
Experience in case management or utilization review preferred.
Licensure as RN/APRN/APC/LPC/LMSW/LCSW preferred.

Responsibilities

Oversee Utilization Review coordinators.
Coordinate with treatment team and physicians.
Obtain pre-certifications and authorizations.
Ensure data collection and reporting to insurers.

Skills

Leadership

Clinical assessment

Communication

Team collaboration

Education

Master's degree in nursing or related field

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.

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.

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