DIR - UTILIZATION REVIEW / MGMT

UHS•Augusta, GA

About The Position

Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15-years. Located in Augusta, GA our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff. Website: https://www.LighthouseCareCenters.com The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical content; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing and accreditation requirements. The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with treatment services. The population served are patients' whose lives are disrupted or complicated by mental illness, behavioral disturbance, substance issues or inability to function or maintain in the community.

Requirements

Masters Degree in nursing, social work, mental health counseling, or related field required with licensure. (RN, APRN, LPC, LMSW, LCSW, etc)
A minimum of five (5) years direct clinical experience in a psychiatric or mental health treatment setting, including one year of managing a related function preferred.
Experience in patient assessment, treatment planning and communication with external review organizations or comparable entities.

Responsibilities

Working manager who oversees the Utilization Review coordinators
Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff
Authorizing entities to ensure initial precertification and continued authorization is achieved
Responsible for aspects relative to timely gathering clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems (Midas)