Director of Utilization Review and Case Management

UHS • Leesburg, VA

105d

About The Position

North Spring Behavioral Healthcare is currently hiring for a Director of Utilization Review (UR) and Case Management! The UR and Case Management Director assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.

Requirements

• Bachelor's degree in human services; Master's degree in human services preferred.
• Three to five years of experience in utilization review and case management.
• RN, LCSW, LPC, LMFT, or LCP in Virginia preferred.
• Current driver's license with a good driving record.
• CPR and First Aid/AED certification.

Responsibilities

• Performs clinical reviews over the telephone.
• Reviews all clinical information in the chart to evaluate the appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases.
• Facilitates discharge planning with treatment team and coordinates continuum of care for the patient with therapists.
• Monitors the effectiveness of patient outcomes.
• Assures and tracks the timely completion of Certificates of Need for each patient.
• Attends treatment team meetings and serves as a liaison and patient advocate between insurance companies and the treatment team.
• Notifies and alerts Chief Financial Officer (CFO) of potential utilization review problems or denials; assists in the preparation and implementation of the appeals process.
• Monitors documentation in clinical records and reports problematic areas to appropriate supervisor, CFO.
• Assists admissions with screening patients on the pre-hospitalization level to ensure admission criteria are met.
• Meets regularly and communicates effectively with all members of the multi-disciplinary team.
• Daily quality assurance oversight and follow-up.
• Performs other duties as assigned/required by this position.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees