Regional Director - Utilization Management
: Job Details :

Responsibilities

Join a dynamic organization driven by our passion for healthcare. UHS is seeking talented individuals who are eager to contribute their expertise and pursue rewarding careers. As a leader in acute care and behavioral health, UHS provides high-quality care to over 3 million patients annually, across our national network of facilities.

The UHS Corporate Care Delivery Strategy Department is hiring a Regional Director - Utilization Management to oversee and guide all aspects of Utilization Management operations within the Behavioral Health Division to maintain effective operations when there is a vacancy in the Behavioral Health division. This position will be based at the facility throughout the division where utilization management oversight is required.

Key Responsibilities include:

Coordinate efforts with corporate departments (i.e., clinical, finance, quality, business office) to align with process improvements.

Conduct regular audits of utilization management processes to identify areas for improvement and ensure compliance with regulations.

Implement utilization management standard practices to optimize utilization management operations and meet divisional utilization management goals.

Provide training and mentorship to local teams, enhancing their understanding of utilization management principles and practices.

Analyze utilization data and trends to develop insights and recommendations for improving care delivery and resource utilization.

Collaborate with the HR department to assist in recruitment efforts and staff training to minimize future staffing gaps.

Qualifications

Bachelor's degree with 5 - 8 years' experience in Utilization Management in either an inpatient psychiatric/substance abuse/rehabilitation setting and/or payer/managed care.

Subject matter expertise in overall management of the appeal and denial process – both from a clinical and administrative perspective.

Ability to apply practice management guidelines to determine medical necessity and appropriateness of care for commercial and federal insurance plans.

Clinical experience and an overall understanding of the internal operations of a behavioral health hospital.

Strong working knowledge of the health care industry and regulatory environment specifically in behavioral health.

Ability to travel up to 70% of the time, including overnight stays.

Independently licensed in Nursing, Social Work or Psychology.

This opportunity provides a rewarding career, challenging and rewarding work environment as well as growth and development opportunities within UHS and its subsidiaries, including competitive compensation, excellent Medical, Dental, Vision and Prescription Drug Plan, and 401k with company match.

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.

We believe that diversity and inclusion among our teammates is critical to our success.

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