Director of Utilization Management/Review

UHS•Hopkinsville, KY

1d•Onsite

About The Position

Cumberland Hall Hospital is a 97-bed, licensed, acute psychiatric hospital located in Hopkinsville, KY. It serves youth, adults, and active-duty military with inpatient acute care, partial hospitalization, and intensive outpatient programs. The hospital cares for over 1500 patients annually. This role oversees all utilization management functions, including precertification, concurrent, and discharge reviews. The Director facilitates regulatory compliance, serves as a key member of the hospital management team, and participates in operations meetings to drive financial and clinical results. This position also acts as a liaison with hospital physicians to align their engagement with payer expectations, patient acuity, and discharge planning. Key responsibilities include leading payer engagement activities (post-payment reviews, audit oversight, denial/appeal oversight), overseeing the Utilization Management committee structure, developing and monitoring utilization management plans, and managing utilization management staff. The Director will also manage their own case-management load while supporting and supervising the Utilization Review team. As a senior leader, this role involves participating as an administrator on call and working evenings and weekends as required.

Requirements

Bachelor’s Degree from an accredited college or university in Nursing, Master’s Degree from an accredited college or university in nursing, social work, mental health, or related field preferred.
A minimum of 3 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.

Responsibilities

Oversees all utilization management functions.
Oversees precertification, concurrent, and discharge utilization reviews.
Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources.
Serves as a key member of the hospital management team.
Acts as a key participant in hospital operations meetings that drive financial and clinical results.
Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements.
Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight.
Oversees the Utilization Management committee structure.
Develops and monitors utilization management plans.
Manages utilization management staff and performs all administrative department head functions.
Responsible for their own case-management load, while supporting and supervising the Utilization Review team.
Participates as an administrator on call and working evenings and weekends as required to support the team.