DIR - UTILIZATION REVIEW / MGMT

Director of Utilization Review/MGMT

Universal Health Services, Inc. company, in partnership with KidLink Community Services, has a long history in providing comprehensive behavioral health care services to at-risk youth struggling with extensive mental health issues. KidLink Community Services recruits foster parents and offers the training to be equipped to provide a safe, stable and therapeutic environment for children and youth that have been removed from their homes. Our training prepares staff and foster parents to support children and youth as they begin the healing process. Our therapeutic foster parents link children and youth to hope, healing and trust.

KidLink Community Services is seeking a dedicated, compassionate Director of Utlilization Review/MGMT to add to our growing team. The primary responsibilities of the Director of Utlization Review/MGMT is to manage and facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting. Completes discharge practices for patients and families upon discharge.

Job Duties/Responsibilities:

• Tracking Performance Based Contracting (PBC) metrics as part of the State of Tennessee contract measuring outcomes and length of stay of patients within the continuum of care
• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer's criteria. Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators
• Provides supervision and training to Case Managers including new and ongoing training regarding essential job duties and functions
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization. Facilitates physician reviews with payers as required. Ensures that clinical and high-risk notifications are provided to key personal
• Completes discharge documentation and distribution of documents to required departments and outside agencies. Schedule discharges for residents including follow up appointments
• Works collectively with the foster care program operations (social services, business office) to ensure timely documentation is aligned with patient conditions
• Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Input data into MS4 and Midas regarding patient authorizations. Acts as backup to Business Office for MS4. Completes Insurance Verification twice monthly per resident
• Establishes and maintains office files to promote efficient retrieval and storage of confidential facility documents and information
• Adheres to company and governmental policies and regulations. Maintains good public relations through positive interactions with vendors, agencies, and referral sources to negotiate and approve all business and other agreements
• Performs other duties as assigned/required by this position

Benefits Highlights

• Challenging and rewarding work environment
• Competitive Compensation
• Mileage Reimbursement
• 401 (k) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• "Perks at Work" employee discount program

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. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. 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.

Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. 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. www.uhs.com

Requirements:

• Bachelor's degree required, master's degree preferred
• Related work experiences required, one (1) to three (3) years, preferred three (3) to five (5) years
• Valid state Driver's License with appropriate endorsement.
• Automobile insurance with verification of medical liability.

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.

Avoid and Report Recruitment Scams

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.