The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient and Partial Hospital services. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, overseeing the response to requests for services and interfaces with managed care organizations, external reviewers and other payers.

Duties include, but are not limited to:

• Direct the response to requests 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.
• 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 the reviews and provide consultation as needed.
• Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
• Establish standards for customer relations and monitor the interactions between Utilization Management staff and customers to evaluate the effectiveness of customer service.
• Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the case management program.
• Participate in clinical team analysis and evaluation of current services offered the facility.
• Ensure strategic program goals and objectives are consistent with the overall organization and facility goals and objectives.
• Develop goals, objectives, policies, and procedures related to the operational needs of the program scenarios.
• Consult with facility management in the development and facilitation of program activities which assure an optimal therapeutic experience for all patients.
• Participate with ensuring that individual patients and their families are involved in the development of individualized treatment plans.
• Develop and maintain a system to minimize and address denials in consult with the facility Business Office Manager and CFO.

Job Requirements

• Bachelor’s degree in Nursing or Master’s degree in Social Work, Mental Health/Behavioral Sciences required. Master’s Degree preferred.
• A minimum of 3 years of clinical experience in an inpatient behavioral health hospital required.
• 2 - 5 years of leadership experience in a related position required.
• Experience with patient assessments, family motivation, treatment planning and communication with external review organizations (i.e. managed care, Medicare, Medicaid) or comparable entities required.
• Knowledge of or experience with patients’ rights, advanced directives, adult and child abuse laws and emergency detention required.
• A valid clinical license in the State of Illinois (LCPS, LCSW, or RN) required.

Lincoln Prairie Behavioral Health Center, located in Springfield, Illinois, is dedicated to providing youth with compassionate mental health treatment that encourages self-responsibility and personal growth. We are the only facility of our kind in Central Illinois. We provide psychiatric treatment to children and adolescents that present with a broad range of psychiatric and behavioral disorders. A clinically skilled multidisciplinary team works to partner with the youth and family to accomplish their goals in a supportive and therapeutic environment.

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. In 2017, UHS was 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.

Lincoln Prairie Behavioral Health offers comprehensive benefits, such as:

• Challenging and rewarding work environment
• Competitive Compensation
• Excellent 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
• Tuition Reimbursement

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.comor 1-800-852-3449.

Job Type: Full-time

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Springfield, IL: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Utilization Review: 3 years (Required)

License/Certification:

• RN, LCSW, or LCPC (Required)

Work Location: One location

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