Utilization Review Manager
UHS
Summary
Manager of Utilization Review Opportunity - 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.
Job description
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.
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
Qualifications
- Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
- Experience: 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
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
Benefits
- Student Loan Repayment
- Tuition Reimbursement
- Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plans
- 401(k) Matching
- Discounted Stock Plan
- SoFi Student Loan Refinancing
- Career Development
- Supervision for Licensure
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.