phoenix | DIR - UTILIZATION MANAGEMENT & REVIEW in Tempe, AZ

DIR - UTILIZATION MANAGEMENT & REVIEW

  • El Paso Behavioral Health System
  • 609 E Rio Salado Pkwy
  • Tempe, AZ 85281
  • Full-Time
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Job Requirements

::Job Requirements:

Education: Experience:

Licensure/Certification: LMSW, LPC, RN or LVN is required.

Licensure/Certification:

Other: Must be at least 21 years of age and be able to obtain and maintain an AZClass 1 Fingerprint Clearance Card.

Other: SKILLS:

1. Knowledge of external review organization (i.e. managed care, Medicare, Medicaid).

2. Knowledge of patients rights, advanced directives, adult and child abuse laws, and emergency detention.

3. Working knowledge of payer resources and financial planning.

4. Demonstrate willingness to acquire knowledge and expertise in complex patient care planning.

5. Skill in organizing and prioritizing workloads to meet deadlines.

6. Excellent leadership, customer relationsand negotiation skills.

Program Planning and Treatment

1. 1. 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.

2. Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.

3. Assure patients are receiving effective and appropriate treatment, based on the level of care.

4. 4. Establish standards for customer relations and monitor the interactions between Utilization Management staff and customers to evaluate the effectiveness of customer service.

5. 5. Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the Utilization Management program.

Personnel Management and Staffing

1. Maintain and allocate a well-qualified core of staff resources.

2. Assure that hiring, disciplinary actions and termination procedures are conducted in accordance with hospital policies

3. Ensure that the staff schedule and configuration will meet the needs and demands of the patient population and census and adjust it accordingly.

Clinical Leadership

1. Conduct department meetings on a regular basis.

2. 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. 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. 3. Ensure the department meets Joint Commission, Medicare and federal and state regulatoryrequirements.

4. 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. 5. Ensure that all deficiencies identified through the performance improvement analysis are addressed with appropriate problem solving actions.

This opportunity offers the following:
  • Challenging and rewarding work environment
  • Growth and Development Opportunities within UHS and its Subsidiaries
  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plan
  • 401k plan with company match
  • One of the nations 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. In 2017, UHS was recognized as one of the Worlds Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of Americas Top 500 Public Companies.

    Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

    Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

    UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to \"UHS or UHS facilities\" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms \"we,\" \"us,\" \"our\" or \"the company\" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including UHS of Delaware, Inc. UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

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    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.