DIR - UTILIZATION REVIEW / CASE MGMT

Responsibilities

Director of Utilization Review (UR) and Case Management

Located in South Central Virginia, The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth's level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.

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 Responsivibilities :

• 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.

Qualifications

Qualifications

Other Requirements :

Benefits :

The Hughes Center is a drug-free and alcohol-free workplace. A pre-hire drug screen, pre-hire background checks, and education verification are required of all new employees.

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE : UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

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