DIR - UTILIZATION REVIEW / MGMT

Fort Lauderdale Behavioral Health Center, is a 182-bed, acute care psychiatric hospital located in the beautiful Oakland Park, neighborhood of Fort Lauderdale, FL. Fort Lauderdale Behavioral features individual units for children, adolescents, adults, and seniors, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 10,000 patients receive care from our compassionate health care team each year. FLBHC provides innovative behavioral health treatment and academic services to children, adolescents, and young adults, including: 24/7 Clinical Assessment Center Inpatient Hospitalization Inpatient Program Residential Treatment Facility and Partial Hospitalization Behavioral Health Rehabilitative Services

We are currently looking for a Director Of Utilization Management to support our Fort Lauderdale, FL campus. The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent interpersonal skills, unquestioned integrity and dedication to their responsibilities and Foundations mission. The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS.

The Director:

• Interfaces with clinical staff as well as managed care organizations, external reviewers and other payers
• Ensures that information is communicated in a straightforward, unbiased and timely manner
• Ensures that the content is accurate and relevant so that recipients can make informed decisions
• Leads the coordination of appeals including tracking and facilitating of physician reviews
• Implements systems and standards related to the utilization review function
• Coordinates the decimation of information to the CEO, CFO, CMO, medical staff, CNO, Director of Compliance, and Director of Clinical Services in a way that facilitates meaningful decision making
• Supports the quality of clinical services by identifying issues and trends preventing successful outcomes in treatment through the utilization review process
• Supervises all Utilization Management activities, including conducting audits to assure medical necessity criteria is met and is clearly documented in the medical record
• Immediately resolves any issues when medical necessity criteria is not met or not clearly documented
• Supervises the Utilization Management Coordinators and assures coverage of all UM related activities

Qualifications:

• Masters degree in social work, counseling or related field with respective licensure (LSW, LCSW, LPC) required
• Must have 3-5 years of Utilization Management experience in a behavioral health inpatient and/or residential setting
• Must be familiar with a variety of insurances and funding streams, including commercial insurance, Medicare/Medicaid
• Must be familiar with community based resources need to coordinate aftercare, both insurance funded and natural supports
• Preferred experience with children and adolescents, and specifically individuals with Autism, intellectual disabilities, or other neurodevelopmental disabilities

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.

Notice: At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience to the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience.