DIR - UTILIZATION REVIEW / MGMT

River Vista Behavioral Health sits along the bluffs overlooking the San Joaquin River, this brand new, 128-bed facility, will provide high-quality and advanced behavioral health services to residents and visitors in the Central Valley. The new hospital will employ more than 250 people, including clinicians, nurses, mental health technicians, support staff and administration.

We are currently seeking a forward thinking and talented Director of Utilization Review to be part of our Leadership Team. The Director of Utilization Management is responsible for directing and overseeing the Utilization Management Program, as well as performs admission and concurrent review of patients. Assures optimum quality of patient care in the most cost-effective manner. Works interdepartmentally to ensure quality of documentation of patient care. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to request for services and interfaces with managed care organizations, external reviewers, and other payers. The Utilization Management Director is responsible for hiring and selection of Utilization Management staff, the development and revision of all UM Department policies and procedures, monitoring performance.

Program Planning and Treatment:

1. Direct the response to request for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.
2. Review the effectiveness of the comprehensive interface with external reviewers, communicate with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of reviews and provide consultation as needed.
3. Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
4. Assure patients are receiving effective and appropriate treatment, based on the level of care.
5. Establish standards for customer relations and monitor the interactions between Utilization Review staff and customers to evaluate the effectiveness of customer service.
6. Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the utilization review program.
7. Maintain current awareness of mental health activities in the community.
8. Maintain an awareness of community and market-related activities which includes knowledge of the activities of other providers, needs of local payers and the political climate related to mental health.

1. Participate in clinical team analysis and evaluation of current services offered at the facility.
2. Strategically solve problems that encompass the larger view of the organization, and establish goals by utilizing an understanding of organizational dynamics in planning and problem solving.

Clinical Leadership:

1. Conduct department meetings on a regular basis.
2. Work with clinical leadership to ensure interdisciplinary treatment planning is organized with participation of all appropriate clinical disciplines.
3. Ensure all patient, family and referral complaints are promptly handled.
4. Coordinate the collection of outcome data within the company deadline.

Continuous Quality Improvement:

1. Ensure that a system is developed to provide continuity of care and communication with family and appropriate referral sources, and ensure the system is evaluated and reviewed regularly.
2. Daily reporting of denials to CFO.
3. Ensure the department meets Joint Commission, Medicare and federal and state regulatory requirements.
4. Develop and implement a Performance Improvement tracking system, evaluate the results quarterly, and report results to the Performance Improvement Committee in a timely manner.
5. Ensure that all deficiencies identified through the performance improvement analysis are addressed with appropriate problem solving actions.
6. Review all department risk management occurrence and ensure that complete and timely reports are submitted to Risk Management.
7. Analyze statistical data of the program to determine and respond to trends.

Additional Standards:

1. Implement planning and teaching staff documentation training.
2. Serves on Facility Committees as assigned.
3. Accepts responsibility for professional growth and development.

1. Demonstrates a professional attitude and supports the objectives of the Facility philosophy through internal and external communications and interactions with all levels of staff, patients, family members, guests, community, and referral sources.
2. Adhere to facility, department, corporate, personnel and standard policies and procedures.
3. Attend all mandatory facility in-services and staff development activities as scheduled.
4. Adhere to facility standards concerning conduct, dress, attendance and punctuality.
5. Support facility-wide quality/performance improvement goals and objectives.
6. Maintain confidentiality of facility employees and patient information

River Vista Behavioral Health offers comprehensive benefits such as:

• Competitive Compensation
• Medical, Dental, Vision, and Prescription Drug Plan
• Generous Paid Time Off
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its Subsidiaries
• Education Assistance
• Challenging and rewarding work environment

Interested applicants may apply directly through our website River Vista Behavioral Health and apply through the Careers tab.

The Director of Utilization Review position requires:

QUALIFICATIONS

Education:

Master's Degree in Social Work, psychology, counseling or related field or a minimum of an Associates in Nursing required. Bachelor's degree in Nursing Preferred. Combination of education and experience may be considered.

Experience:

A minimum of three (3) to five (5) years direct Utilization Management, clinical experience in a psychiatric, mental health, and chemical dependency treatment setting. A minimum of one year of managing a related function and communication with external review organizations or comparable entities is preferred.

Licensure: RN, MSW

Additional Requirements: A strong knowledge of JCAHO, HCFA, OSHA regulations, and patient rights standards and all other applicable federal and state laws and regulations governing mental health care facilities.

One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. UHS is recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.

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.

Notice:

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.