Director of Utilization Review

Utilization Review Director Opportunity -

HRI Hospital is seeking a Director of Utilization Review to join our skilled and dedicated team of psychiatric professionals, who provide service excellence to our patients in a range of inpatient and partial programs and services. This is a 40 hour per week, salaried position.

About Us

HRI Hospital is 66-bed psychiatric facility with adult inpatient services and several partial hospitalization programs. We are part of the largest private mental health system in Massachusetts and can therefore provide competitive salaries, benefits, and opportunities for growth and development. At the same time, the smaller size of our facility allows us to provide personalized attention and training to all our employees. Employees are part of a multi-disciplinary team of dynamic professionals providing high quality care to a diverse inpatient and outpatient group of individuals. We are located in Brookline – right near Boston University and Coolidge Corner – and provide easy access to public transportation and free parking. Employees are our most valued asset and we encourage qualified individuals to apply.

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The Director of Utilization Review is responsible for coordinating needed aspects of in-house treatment (inpatient, partial hospitalization, outpatient, and crisis) to ensure clinically responsible compliance with managed are utilization review expectations and contract performance standards.

Benefit Highlights

Challenging and rewarding work environment

Competitive Compensation & Generous Paid Time Off

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!

Further your education at a low cost through our Tuition Discount partnership with Chamberlin University

Responsibilities

Negotiate full authorization of days through the provision of timely concurrent information that includes patient status, treatment, and anticipated discharge

Provide clinical information to managed care organizations that recognizes their review style, criteria, performance standards, and needs

Maintains, as needed, documentation supporting information provided to MCO on patient status

Coordinates the appeal of clinically denied days with managed care organizations and monitor results

Consistently communicates with clinical departments, managed care organization’s assessment of patient status, anticipated discharge, and needed action plans.

Builds collaborative relationships with needed clinical departments

Proactively identifies patients at risk for denied days and works with treatment teams to minimize appeal risk

Audits Medicare files by verifying initial medical necessity: certifications of all Medicare admissions, re-certifications of all Medicare inpatients as required. Audits Medicare files for inpatients and partial programs. Prepares analyses of these audits and presents these findings to the CEO and the Quality Management Committee

Participates in daily morning meetings with the CEO, reporting on admissions, managed care updates, and certifications, along with any associated problems

Collaboratively work with Business Office to identify and appeal denied days within designated contractual protocols

Maintain senior management, medical staff, and clinical departments awareness of significant utilization issues and trends via production of written reports describing utilization trends

Provide utilization information as requested by supervisor, hospital CEO, or other departments in a timely and accurate fashion

Participate in CQI process and contribute to overall improvement of care delivery

Maintain Utilization Management files

Convene Utilization Management Committee on a quarterly basis, develop needed agenda, and ensure completion and filing of minutes

Act as Administrator-on-call and provide guidance and direction during emergency situations requiring AOC notification

About Universal Health Services

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.

Requirements

Education: Master’s in psychology, social work or related field OR ADN/BSN & Registered Nurse in Massachusetts

Experience: 2 years behavioral health utilization review/managment experience required

License: LCSW, LMHC, or LICSW preferred OR RN

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.

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

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