Director of Utilization Management

UHS • Dover, DE

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About The Position

Utilization Management Director Opportunity
Dover Behavioral Health System is a 104-bed, acute care psychiatric hospital located in the beautiful Dover, Delaware area. Dover Behavioral Health System features individual units for adolescents and adults and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 10,000 patients receive care from our compassionate health care team each year at Dover Behavioral Health System. This opportunity offers working at a hospital known for its outstanding patient satisfaction, including ranking 6th for highest patient satisfaction in 2020 compared to over 200+ psychiatric hospitals. We attribute this success to our talented and dedicated staff. We are the best at what we do!
Dover Behavioral Health System is currently seeking a dynamic Utilization Management Director to lead our Utilization Review department. This position manages a team of Utilization Management Coordinators dedicated to providing exceptional case management to ensure proper services are provided to our patients.
Benefits for the position include:
· Competitive Compensation & Generous Paid Time Off (29 days off in the first year!)
· Excellent Medical, Dental, Vision and Prescription Drug Plans
· 401(K) with company match and discounted stock plan
· SoFi Student Loan Refinancing Program
· Career development opportunities within UHS and its 300+ Subsidiaries!
· Tuition and Licensure Assistance
· Challenging and rewarding work environment

Requirements

• College Degree in Finance, Social Work or related field, or RN license
• Two years management experience
• Experience processing utilization reviews, preferably for behavioral health claims

Responsibilities

• Conducts admission reviews working with Assessment and Referral Center to stay abreast of admissions
• Conducts concurrent and extended stay reviews on appropriate day and/or specified time.
• Monitors Medicare cases for compliance with CMS standards through concurrent audits. Complete Medicare report for data reporting to management team and corporate
• Prepares and submits appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position
• Maintains and updates logs of review and maintain other appropriate records of the Utilization Review department
• Remains current on applicable UR trends and regulations and reviews current policies and procedures for compliance
• Serves on DBHS Management Team
• Performs personnel management duties
• Adheres to hospital’s FTE standards and serve as the department’s fiscal manager
• Prepares and submits reports (CFO and Denial Reports Bi-Weekly) requested by CFO, CEO and Risk Manager
• Serve as an Administrator on Call

Benefits

• Competitive Compensation & Generous Paid Time Off (29 days off in the first year!)
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Tuition and Licensure Assistance
• Challenging and rewarding work environment

What This Job Offers

• Job Type: Full-time
• Career Level: Manager