What are the responsibilities and job description for the UTILIZATION REVIEW DIRECTOR position at UHS?
Hermitage Hall (a UHS company) is one of Middle Tennessee's largest stand-alone psychiatric residential treatment Hospitals. Licensed by Tennessee Department of Mental Health and Substance Abuse Services as a mental health residential treatment center for children and youth, Hermitage Hall has provided services to families for over 30 years.
We are looking for Utilization Review Director to join our team of dedicated professionals. Come help us grow and make a difference in our children's life's.
This role requires a full background check including fingerprint, drug screen, and employment verification.
JOB SUMMARY
This position proactively monitors utilization of continuum services for residents at Hermitage Hall. He/She is responsible for concurrent, retro, and extended stay reviews as well as precertification of residents prior to admission. This position is responsible for submitting appeals and/or coordinating peer to peer reviews if continued authorization is denied. He/She actively communicates and coordinates with multiple departments regarding utilization needs. He/She facilitates and fosters positive relationships with insurance and other outside agencies. He/She works diligently to optimize reimbursement and authorized days for Hermitage Hall residents.
At the discretion of the Director of Admissions and Utilization Review, and based on the needs of the facility, this position will assist in the pre-admission and admission processes. This could include but is not limited to reviewing referral packets, communicating with referral sources, scheduling admissions, presenting program information to outside providers and guardians, and completing the Hermitage Hall admission process of residents.
This opportunity provides the following:
- Challenging and rewarding work environment
- Growth and development opportunities within UHS and its subsidiaries
- Competitive Compensation
- Excellent Medical, Dental, Vision and Prescription Drug Plan
- 401k plan with company match
- Generous Paid Time Off
- Free meals
Qualifications
Utilization Review Director Job Requirements
EDUCATION
- Minimum of a Bachelor’s Degree in the area of Counseling, Psychology, or Social Services related field or Nursing BSN or RN. Masters level preferred.
EXPERIENCE
Minimum of two years’ experience working with emotionally disturbed individuals, preferably in a residential or acute care setting. Knowledge of managed care organizations. Demonstrates understanding of third party reimbursement and processes involved; works well in prioritizing review processes within a managed care environment uses ability to interpret admission and continued stay criteria to advocate for appropriate maintenance of benefits. Demonstrates clear and consistent understanding of admission and discharge functions and can discuss current psychopathology with reviewers utilizing integrated clinical knowledge relating to diagnosis to evidenced clinical documentation. Demonstrates the ability to provide meticulous record keeping and organizational skills. Mastery computer skills. Working knowledge of spreadsheet, database, word processing programs, and internet usage.
We believe that diversity and inclusion among our teammates is critical to our success.At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
EEO Notice
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.
