MGR - CENTRAL APPEALS OFFICE

UHS•Brentwood, TN

25d•Remote

About The Position

BH Shared Services (a UHS company) located in Brentwood, TN is currently seeking an experienced Manager-Central Appeals Office to join our established team. POSITION SUMMARY: Manager-Centeral Appeals office-This position will oversee all operations in all markets of the CAO and provide leadership and management to ensure overall quality, compliance and timeliness occurs for all post service appeals. This position will serve as the liaison to all facilities supported by the CAO to streamline and support utilization management (appeals) operations to ensure maximum benefit of capitalizing on all financial recovery efforts. This position must have at least five years’ experience in utilization management in either an in-patient psychiatric/substance abuse/rehabilitation setting and/or payer/managed care environment and three years of leadership experience. This is a fully remote position.

Requirements

Bachelor's degree required, Master's preferred
Master's level clinician required,Licenusre preferred
5-8 years related experience required, 8-10 preferred
Ability to apply practice management guidelines to determine medical necessity and appropriateness of care for commercial and federal insurance plans.
Subject matter expertise in overall management of the appeal and denial process –both from a clinical and administrative perspective.
Clinical experience and an overall understanding of the internal operations of a behavioral health hospital
Strong interpersonal and communication skills—both written and verbal
Strong working knowledge of the health care industry and regulatory environment specifically in behavioral health
Proficient with word processing –including excel, PowerPoint.

Responsibilities

Leadership responsibility for all appeal inventory and productivity across all markets, ensuring timely completion of appeals.
Serves as the primary liaison to facilities to maintain alignment and consistency in appeal operations.
Assists with training and mentorship to the Market Appeals Specialist/ Appeals Support Specialist enhancing their understanding of appeal management principles and practices.
Supports initiatives that drive performance improvement through technology advancements and expansion efforts in the division.
Performs other duties as assigned/required by this position.