Utilization Review Manager

UHS • Attleboro, MA

8d • Onsite

About The Position

Fuller Hospital is a 109-bed licensed, private psychiatric facility located in South Attleboro, Massachusetts providing inpatient and outpatient behavioral health services to residents of Massachusetts and Rhode Island. Inpatient units are designed to treat adults with general psychiatric or intellectual disabilities, as well as adolescents with general psychiatric issues. Patients with co-occurring psychiatric and substance abuse disorders can be treated on most units. Fuller Hospital also provides a less intensive Partial Hospitalization Program (PHP) to patients with psychiatric and co-occurring psychiatric and substance abuse disorders.
The Manager of Utilization oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement. This is a full time, 40 hour per week position.

Requirements

• Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
• Three (3) or more years of experience in Utilization Review strongly preferred
• At least one (1) year of direct supervisory experience preferred
• Moderate to Expert knowledge of Insurance procedures and terminology as well as Billing procedures and terminology
• Basic knowledge of psychiatric and addictive disease diagnosis and treatment.
• Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation
• Leadership skills and ability to provide feedback and coaching to employees
• Ability to problem-solve and exercise sound time management
• 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

Responsibilities

• Oversees all utilization management functions
• Oversees precertification, concurrent, and discharge utilization reviews
• Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources
• Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results
• Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements
• Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight
• Manages utilization management staff and performs all administrative department head functions
• Performs other duties as assigned/required by this position

Benefits

• Student Loan Repayment - $200 per month
• Tuition Reimbursement - $5,000 per year
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off (26 days per year + roll over)
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Supervision for Licensure

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed