SUPV - UTILIZATION REVIEW

UHS•Sherman, TX

73d

About The Position

Texoma Medical Center, a 414-bed acute care facility has been providing quality health care to the residents of North Texas and Southern Oklahoma since 1965. Our main campus is located in Denison, Texas, approximately one hour north of the Dallas/Fort Worth area and just south of the Texas/Oklahoma border. In addition, we have numerous facilities in locations throughout the Texoma region. Since 1965, TMC has forged a special relationship with the people of North Texas and Southern Oklahoma. Texoma residents have come to depend on TMC to meet a spectrum of physical, mental and spiritual needs. TMC has responded with unique services to provide the kind of sophisticated, experienced care that was once was available only in major metropolitan areas. We offer major specialty services including open heart surgery and neurosurgery. Advanced resources such as certified trauma care support TMC's role as a regional specialty center. One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com The UM Supervisor oversees the utilization management of the Behavioral Health Center including, but not limited to ensuring timely authorizations and filing, utilization review, case documentation, payer relationships, denial/appeal cases, regulatory requirements, staff management, and department administration. This position supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement. The UM Supervisor is responsible for attending or ensuring department representation in BHC treatment team meetings. The UM Supervisor oversees the annual creation/revision and adherence to the BHC UM Plan in collaboration with BHC CEO and hospital CFO and is responsible for co-leading the BHC UM Committee Meeting. The UM Supervisor also participates in the hospital Revenue Cycle Committee and additional committee meetings as assigned by leadership. The UM Supervisor is responsible for implementing changes to support UM goals and collaboration with the CBO as needed. This position oversees the Utilization Management Coordinator. The UM Supervisor reports directly to the BHC CEO but also has a dotted line of reporting to the hospital Director of Revenue Cycle Billing and CFO Hours are based on departmental and facility needs and may include day, evening, and weekend hours, as directed by BHC CEO. Participates in Administrator on Call if requested by BHC CEO.

Requirements

Per licensure requirements for LPC, MSW, LCSW, or RN.
A minimum of 5-7 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.
Current State of Texas license LPCA, LPC, LMSW, LCSW, LVN, or RN.
Handle with Care and Verbal De-Escalation training must be completed within 60 days of hire/transfer and annually thereafter. Additional training to be completed with respective timeline.
Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.
Experience using data to identify trends.
Ability to manage team productivity and compliance with required timelines.
Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations.
Demonstrate excellent interpersonal skills, verbal and written communication skills.
Must possess critical thinking skills and sound decision making and problem-solving abilities.
Must be organized, thorough and ensure appropriate follow-though.
Must be service excellence focused (strong customer service and team building skills).
Must work harmoniously with physicians, clinical staff, administration, nursing and ancillary staff.
Demonstrate flexibility.
Must demonstrate knowledge and skill in the behavioral health clinical treatment modalities.
Knowledge of Psychiatric/Chemical Dependency Treatment in the State of Texas must be able to identify and address the special needs of adolescent, adult, geriatric patients.
Practices teamwork

Responsibilities

ensuring timely authorizations and filing
utilization review
case documentation
payer relationships
denial/appeal cases
regulatory requirements
staff management
department administration
attending or ensuring department representation in BHC treatment team meetings
oversees the annual creation/revision and adherence to the BHC UM Plan in collaboration with BHC CEO and hospital CFO
co-leading the BHC UM Committee Meeting
participates in the hospital Revenue Cycle Committee and additional committee meetings as assigned by leadership
implementing changes to support UM goals and collaboration with the CBO as needed
oversees the Utilization Management Coordinator
Participates in Administrator on Call if requested by BHC CEO