Director of Utilization Management (UM) / Utilization Review (UR)

UHS•Auburn Hills, MI

About The Position

HAVENWYCK HOSPITAL (a UHS facility) Havenwyck Hospital s a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate behavioral health services to children, adolescents and adults. It is the ultimate goal of our dedicated staff to build strength, confidence and knowledge within each patient, in hopes that they may continue learning and understanding their needs and practicing self-care for the rest of their lives. For more information, please visit us at www.havenwyckhospital.com POSITION SUMMARY: Oversee utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.

Requirements

Bachelor's Degree in Nursing or Master's Degree in Psychology or Social required.
Valid license in the State of MI as a fully licensed Social Worker, Marriage and Family Therapist, Professional Counselor (i.e. LMSW, LMFT, LPC, LP), or Registered Nurse
8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.
Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.
Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines.
Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations
Excellent oral and written communication skills that drive departmental hospital engagement.

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.
Directs utilization management staff and performs all administrative department head functions.
Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.
Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines.
Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations
Excellent oral and written communication skills that drive departmental hospital engagement.