Utilization Management Director Pediatric Behavioral Health

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

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