Director - Utilization Review - Full-time

Behavioral Health System, Inc.; Memphis (TN); On-site; USD 110,000 - 160,000; Full time

Benefits offered by this job

Challenging and rewarding work env.

Career development opportunities

Competitive compensation & generous PT

Excellent medical, dental, vision & Rx

401k with company match

SoFi student loan refinancing

Tuition savings for nursing education

Pet insurance

Job summary

Lakeside Behavioral Health System is seeking a seasoned healthcare leader to oversee utilization management, case documentation, payer relationships, regulatory requirements, and department administration. This role drives hospital performance, patient satisfaction, and compliant reimbursement.

Qualifications include a Masters in a health-related field, 8–10 years in acute inpatient psychiatry or 5–7 years in utilization management, and preferred TN licensure (RN/LCSW/LPC).

Qualifications

• Masters prepared healthcare leader/director in Nursing, Counseling, Psychology or Social Work.
• 8-10 years in an acute inpatient psychiatric setting as a treatment team member, or 5-7 years in utilization management for mental health/substance abuse behavioral health disorders.
• Valid TN RN license, LCSW, or LPC preferred.
• Knowledge of managed care payer practices, DSM-V codes, and data-driven trend analysis; ability to drive compliance and performance.

Responsibilities

• Oversees utilization management including utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration.
• Supports the hospital's success, patient satisfaction, regulatory compliance and optimal reimbursement.

Skills

Communication skills

Team leadership

Regulatory compliance

Education

Masters prepared healthcare leader/director (Nursing, Counseling, Psychology or Social Work)

Job description

Responsibilities

Lakeside Behavioral Health System provides an excellent opportunity for those seeking to be part of a team-oriented and compassionate organization. Our staff tell us that our team is their number one reason for working at Lakeside and we offer competitive compensation, excellent comprehensive benefits, opportunities for advancement, tuition assistance, and paid time off.

Since 1969, Lakeside has been the premier provider of specialized behavioral health and addictive disease services in the Memphis and Mid-South region. The 365-bed facility is one of the largest free-standing psychiatric hospitals in the United States. We are located on a serene 37-acre campus in northeast Shelby County, serving as the setting for the treatment for children, adolescents, young adults, adults and seniors. Lakeside’s comprehensive programs treat disorders such bipolar disorder, psychological trauma, depression and anxiety, mental illness and addictive disease disorders such as alcoholism, drug addiction and substance abuse.

Job Description

Oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.

This opportunity provides the following:

• Challenging and rewarding work environment
• Career development opportunities within UHS and its 300+ subsidiaries
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401k with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Tuition savings to continue your nursing education with Chamberlain University
• Pet Insurance
• More information is available on our Benefits Guest Website: benefits.uhsguest.com.

About Universal Health Services (UHS)

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.

Qualifications

Job Requirements

Education: Masters prepared healthcare leader/director (Nursing, Counseling, Psychology or Social Work).

Experience: A minimum of 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders

Licensure/Certification: Valid TN RN license, LCSW, or LPC preferred.

Knowledge: Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations. Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation. Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines. Excellent oral and written communication skills that drive departmental hospital engagement.

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.