DIR - UTILIZATION REVIEW / MGMT

UHS•Augusta, GA

2d•Onsite

About The Position

Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Director of Utilization Review to join their growing team. This facility has been providing psychiatric services for over 15 years in Augusta, GA, offering a therapeutic setting for individuals seeking treatment for mental illness. The Director of Utilization Review is a crucial part of the Lighthouse Case Management Team, responsible for integrating and coordinating a patient-centric therapeutic strategy with a strong focus on clinical content. The role ensures high-quality, cost-effective treatment aligns with the mission, vision, and values of Universal Health Services (UHS) and meets all government regulations, licensing, and accreditation requirements. This position involves collecting, analyzing, and presenting clinical data to insurance providers to secure authorizations and coordinate treatment services for patients experiencing mental illness, behavioral disturbances, substance issues, or difficulties functioning in the community.

Requirements

Masters Degree in nursing, social work, mental health counseling, or a related field.
Minimum of five (5) years of direct clinical experience in a psychiatric or mental health treatment setting.
Experience in patient assessment, treatment planning, and communication with external review organizations or comparable entities.
One year of managing a related function is preferred.

Nice To Haves

Licensure as RN, APRN, APC, LPC, LMSW, LCSW is preferred.

Responsibilities

Oversees Utilization Review coordinators as a working manager.
Participates in treatment team meetings and collaborates with physicians, therapists, nurses, and other relevant staff.
Obtains initial precertification and continued authorization from authorizing entities.
Responsible for the timely gathering, communication, and entry of clinical criteria into computer-based systems (Midas).