DIR - UTILIZATION REVIEW / MGMT

UHS•Oakland Park, FL

5d•Onsite

About The Position

Fort Lauderdale Behavioral Health Center is a 182-bed, acute care psychiatric hospital seeking a Director Of Utilization Management to support its Fort Lauderdale, FL campus. The facility offers inpatient acute care, partial hospitalization, and intensive outpatient programs for children, adolescents, adults, and seniors. The Director of Utilization Management is responsible for ensuring the utilization review process meets the integrity standards set by FLBHC and UHS, interfacing with clinical staff, managed care organizations, external reviewers, and other payers. This role ensures information is communicated accurately and timely for informed decision-making and leads the coordination of appeals. The Director is responsible for implementing systems and standards for utilization review, including the Utilization Management Plan, and ensuring adherence to regulatory standards. This position supports the quality of clinical services by identifying issues and trends that hinder successful treatment outcomes through utilization review. The Director supervises all Utilization Management activities, including conducting audits for medical necessity criteria and resolving any identified issues. They also supervise Utilization Management Coordinators and ensure coverage of all UM-related activities.

Requirements

Masters degree in social work, counseling or related field with respective licensure (LSW, LCSW, LPC) required.
Must have 3-5 years of Utilization Management experience in a behavioral health inpatient and/or residential setting.
Must be familiar with a variety of insurances and funding streams, including commercial insurance, Medicare/Medicaid.
Must be familiar with community based resources need to coordinate aftercare, both insurance funded and natural supports.

Nice To Haves

Preferred experience with children and adolescents, and specifically individuals with Autism, intellectual disabilities, or other neurodevelopmental disabilities.

Responsibilities

Ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS.
Interfacing with clinical staff as well as managed care organizations, external reviewers and other payers.
Ensuring that information is communicated in a straightforward, unbiased and timely manner.
Ensuring that the content is accurate and relevant so that recipients can make informed decisions.
Leading the coordination of appeals including tracking and facilitating of physician reviews.
Implementing systems and standards related to the utilization review function, including the implementation of the Utilization Management Plan and ensuring its adherence to all regulatory standards.
Coordinating the dissemination of information to the CEO, CFO, CMO, medical staff, CNO, Director of Compliance, and Director of Clinical Services in a way that facilitates meaningful decision making.
Supporting the quality of clinical services by identifying issues and trends preventing successful outcomes in treatment through the utilization review process.
Supervising all Utilization Management activities, including conducting audits to assure medical necessity criteria is met and is clearly documented in the medical record, immediately resolving any issues when medical necessity criteria is not met or not clearly documented.
Supervising the Utilization Management Coordinators and assuring coverage of all UM related activities.