DIR - UTILIZATION REVIEW / MGMT

UHS•Harahan, LA

2d•Onsite

About The Position

River Oaks Hospital, located in metropolitan New Orleans, Louisiana, is a private psychiatric facility for adults, adolescents and children. Since 1970, River Oaks has established a tradition of excellence in the treatment of acute psychiatric illness, dual diagnosis, alcohol and drug detoxification, trauma based disorders, compulsive behaviors, and eating disorders, River Oaks has provided quality treatment to service individuals suffering from mental illness, and/or addictive disorders. Situated on a 14-acre campus, services are available at all levels of care (inpatient, day or partial hospitalization, outpatient, and intensive outpatient). River Oaks Hospital is seeking a dynamic and talented UTILIZATION REVIEW DIRECTOR to direct and serve within the Utilization Management team. Evaluates patient medical records to determine severity of patient’s illness and the appropriateness of level of care. Serves as liaison for patients and facility with insurance companies. Negotiates and advocates for patient length of stay and level of care. Coordinates utilization review activities with other departments to ensure reimbursement for services provided by the facility. Promotes patient care consistent with the philosophy and objectives of River Oaks Hospital. Performs duties in accordance with the ANA Standards of Practice for Psychiatric Mental Health Care, and facility mission, values, policies, and behavioral standards.

Requirements

3-5 years clinical experience with a psychiatric mental health population desired.
2-3 years experience in Utilization Review.
Bachelors prepared healthcare professional (Nursing, Counseling, Psychology or Social Work).
Possesses knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc.
Current knowledge of regulating /accrediting agency guidelines.
Treat Everyone As a Guest
Demonstrate Professionalism and Excellence in all things I do.
Practice Teamwork

Nice To Haves

Management experience preferred.
Masters preferred.
Registered Nurse (RN), Licensed Therapist or Social Worker (LPC/LMSW/LCSW) preferred.
Basic knowledge of statistical analysis desired.

Responsibilities

Evaluates patient medical records to determine severity of patient’s illness and the appropriateness of level of care.
Serves as liaison for patients and facility with insurance companies.
Negotiates and advocates for patient length of stay and level of care.
Coordinates utilization review activities with other departments to ensure reimbursement for services provided by the facility.
Promotes patient care consistent with the philosophy and objectives of River Oaks Hospital.
Performs duties in accordance with the ANA Standards of Practice for Psychiatric Mental Health Care, and facility mission, values, policies, and behavioral standards.