Are you someone who views challenges more like opportunities? Do you excel as a people motivator? Are you a skilled negotiator with a good understanding of hospitalization insurance? Are YOU A LEADER!??!
Answering yes makes you who we are looking for to excel in an exciting career opportunity as the Director of Utilization Management for SBHS!
EXPERIENCE/EDUCATION: Bachelor’s Degree in Nursing or Master's degree in psychology or mental/health/human services field is REQUIRED; A minimum of five (5) years direct clinical experience in a medical-psychiatric, psychiatric or mental health setting and at least three years’ experience in utilization management is REQUIRED. Skills in consumer assessment, motivating families and other resources, treatment planning, and communicating with external review organizations or comparable entities is preferred. A minimum of two (2) years supervisory experience is preferred.
LICENSURE/CERTIFICATION: R.N., LPC/LCPC, or LSW/LCSW REQUIRED. Primary Source Verification shall be required through Illinois Department of Professional Regulations. Other relevant credentials may be accepted at the discretion of the CEO and Director of Human Resources
The Director of Utilization Management is responsible for the oversight of the utilization management department. Responsibilities include monitoring team members to initiate authorization of benefits, Medical Necessity for ongoing treatment, and guiding teams to next level of care step down for patients.
Work closely with several departments including Physicians, Nursing, and Therapist on documentation and importance of Medical Necessity. Help treatment teams with oversight of the flow of treatment activities offered to the consumer, including the clinical screening for appropriation of potential admissions, and appropriate level of care, initiation of treatment phase(s), interface with the treatment team, interface with external case managers and managed care organizations, oversight and implementation of discharge planning and customer service.
The Director will analyze data to track trends including length of stay, documentation meeting medical necessity, and appropriateness of treatment for level of care. Provide trainings to improve clinical documentation and meet goals set on appeals and denials. Run UM committee meetings providing reports to the quality committee.
Benefits include:
- 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
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
Job Type: Full-time
Pay: $93,500.00 - $120,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Tuition reimbursement
- Vision insurance
Healthcare setting:
Medical specialties:
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
- Weekends as needed
Education:
Experience:
- Supervisory: 2 years (Preferred)
- Utilization Review in a psychiatric or mental health setting: 5 years (Required)
License/Certification:
- LPC/LSW (Preferred)
- LCPC/LCSW (Preferred)
Work Location: In person