Director of Utilization Management

The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient and Partial Hospital services.  This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, overseeing the response to requests for services and interfaces with managed care organizations, external reviewers and other payers.

Duties include, but are not limited to:

• Direct the response to requests for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.
• Review the effectiveness of the comprehensive interface with external reviewers, communicate with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of the reviews and provide consultation as needed.
• Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
• Establish standards for customer relations and monitor the interactions between Utilization Management staff and customers to evaluate the effectiveness of customer service.
• Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the case management program.
• Participate in clinical team analysis and evaluation of current services offered the facility.
• Ensure strategic program goals and objectives are consistent with the overall organization and facility goals and objectives.
• Develop goals, objectives, policies, and procedures related to the operational needs of the program scenarios.
• Consult with facility management in the development and facilitation of program activities which assure an optimal therapeutic experience for all patients.
• Participate with ensuring that individual patients and their families are involved in the development of individualized treatment plans.
• Develop and maintain a system to minimize and address denials in consult with the facility Business Office Manager and CFO.

Requirements:

• Bachelor’s degree in Nursing or Master’s degree in Social Work, Mental Health/Behavioral Sciences required. Master’s Degree preferred.
• A minimum of 5 years of clinical experience in an inpatient behavioral health hospital required.
• 3 - 5 years of management experience in a related position required.
• Experience with patient assessments, family motivation, treatment planning and communication with external review organizations (i.e. managed care, Medicare, Medicaid) or comparable entities required.
• Knowledge of or experience with patients’ rights, advanced directives, adult and child abuse laws and emergency detention required.
• A valid clinical license in the State of Illinois (LCPS,LCSW,or R.N) required.