Director of Utilization Review and Case Management

Director Of Utilization Review And Case Management

North Spring Behavioral Healthcare is currently hiring for a Director of Utilization Review (UR) and Case Management. The UR and Case Management Director assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.

Key Responsibilities :

• Performs clinical reviews over the telephone.
• Reviews all clinical information in the chart to evaluate the appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases.
• Facilitates discharge planning with treatment team and coordinates continuum of care for the patient with therapists.
• Monitors the effectiveness of patient outcomes.
• Assures and tracks the timely completion of Certificates of Need for each patient.
• Attends treatment team meetings and serves as a liaison and patient advocate between insurance companies and the treatment team.
• Notifies and alerts Chief Financial Officer (CFO) of potential utilization review problems or denials; assists in the preparation and implementation of the appeals process.
• Monitors documentation in clinical records and reports problematic areas to appropriate supervisor, CFO.
• Assists admissions with screening patients on the pre-hospitalization level to ensure admission criteria are met.
• Meets regularly and communicates effectively with all members of the multi-disciplinary team.
• Daily quality assurance oversight and follow-up.
• Performs other duties as assigned / required by this position.

Location : Beautiful Leesburg, Virginia, 40 miles Northwest of Washington DC. Named one of the best places to live by Money magazine. 45-acre campus in a rural area on the northern edge of Leesburg with a gymnasium, beautiful outdoor campus and high ropes course. Excellent public school system.

North Spring Behavioral Healthcare, Inc. is a multifaceted behavioral healthcare system comprised of three programs to serve children and adolescents with a broad spectrum of psychiatric service needs. Programs of service include an 87-bed, Virginia Department of Behavioral Health and Developmental Services licensed, Joint Commission accredited psychiatric residential treatment facility, a Partial Hospitalization Program, and a 40-bed acute psychiatric hospital.

Our strategic plan for the past two years has been centered on improving fidelity to our evidence-based clinical methodology. North Spring is part of Universal Health Services, Inc. (UHS) one of the Nation's largest and most respected healthcare management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide.

EEO Statement : All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams : We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Qualifications : Bachelor's degree in human services; Master's degree in human services preferred. Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia preferred. Current driver's license with a good driving record. CPR and First Aid / AED certification.