Director of Utilization Management

The Hughes Center; Hollys Mill (VA); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Excellent Medical, Dental, Vision

401(k) with company match

Paid Time Off

Career Development

Employee Meals

Stock purchase discount

Job summary

The Hughes Center, a structured psychiatric residential treatment facility for youth, seeks a Director of Utilization Management to lead admission screening, ensure criteria alignment, and coordinate across clinical, medical records, and payor relations. You’ll drive chart accuracy for admission, continued stay, and discharge, partnering with departmental leaders to optimize patient care.

The role requires strong data analysis, communication with families and payors, and the ability to balance

Qualifications

• Bachelor's degree in human services required or preferred.
• Three to five years of experience in utilization review/case management.
• RN, LCSW, LPC, LMFT, or LCP in Virginia required.
• Basic understanding of medical terminology, residential treatment, psychiatric disorders.
• Must know how to gather and analyze data.
• Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians.

Responsibilities

• Coordinate UM program development, implementation, and monitoring with third party payors and CARF standards.
• Review clinical data with third party reviewers to substantiate level of care.
• Communicate and coordinate reviewers’ decisions with clinical and administrative staff.
• Facilitate physician reviews with medical staff and third party reviewers.
• Attend daily multidisciplinary treatment team meetings.
• Retrospective appeals to third party payers.
• Disseminate UM statistics and utilization data.
• Other duties as assigned.

Skills

Data analysis

Clear communication

Initiative

Judgement

Basic computer skills

Education

Bachelor's degree in human services

Master's degree in human services (preferred)

Job description

Responsibilities

The Hughes Center is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare professionals!

The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth’s level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.

Visit us online: www.thehughescenter.com

Position Summary

The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.

Key Accountabilities & Duties

• Coordinates the development, implementation and monitoring of facility-wide UM program consistent with third party payors, managed care, Federal, State, and CARF standards.


• Develops systems to review and respond to concerns expressed by customers. Together with the appropriate Department Head, he/she works to resolve issued to the satisfaction of the customer and facility. The Director of UM recommends changes in order to protect the integrity of our customer commitment pledge.


• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.


• Communicate and coordinate third party reviewer’s level of care decisions and expectations to appropriate clinical and administrative staff.


• Facilitate physician reviews with medical staff and third party reviewers.


• Attend daily multidisciplinary treatment team meetings.


• Coordinates and makes Retrospective Appeals to third party payers.


• Complies, analyzes, and disseminates information and statistics relative to UM, including monthly facility utilization data, medical record chart reviews, service utilization, and special surveys.


• Other duties as assigned.

Benefits

• Home/Work Life Balance


• Excellent Medical, Dental, Vision, and Prescription Drug plans


• 401(k) Retirement Plan with company match


• Life Insurance


• Flexible Spending or Health Savings Account


• Generous Paid Time Off


• Career Development Opportunities within UHS and its subsidiaries


• A Challenging and Rewarding Work Environment


• Free meals!


• Company stock purchase discount


• Employee Assistance Program

Qualifications

• Bachelor's degree in human services; Master's degree in human services preferred.


• Three to five years of experience in utilization review and case management.


• RN, LCSW, LPC, LMFT, or LCP in Virginia required.


• Basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.


• Must know how to gather and analyze data.


• Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing.


• Must demonstrate initiative, tact and good judgement.


• Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources.


• Must have basic computer skills.

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.

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.