Director of Utilization Management

The Hughes Center is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare professionals!

The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth’s level of functional independence.

Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.

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The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.

• Coordinates the development, implementation and monitoring of facility-wide UM program consistent with third party payors, managed care, Federal, State, and CARF standards.
• Develops systems to review and respond to concerns expressed by customers. Together with the appropriate Department Head, he/she works to resolve issued to the satisfaction of the customer and facility. The Director of UM recommends changes in order to protect the integrity of our customer commitment pledge.
• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
• Communicate and coordinate third party reviewer’s level of care decisions and expectations to appropriate clinical and administrative staff.
• Facilitate physician reviews with medical staff and third party reviewers.
• Attend daily multidisciplinary treatment team meetings.
• Coordinates and makes Retrospective Appeals to third party payers.
• Complies, analyzes, and disseminates information and statistics relative to UM, including monthly facility utilization data, medical record chart reviews, service utilization, and special surveys.
• Other duties as assigned.

• Home/Work Life Balance
• Excellent Medical, Dental, Vision, and Prescription Drug plans
• 401(k) Retirement Plan with company match
• Life Insurance
• Flexible Spending or Health Savings Account
• Generous Paid Time Off
• Career Development Opportunities within UHS and its subsidiaries
• A Challenging and Rewarding Work Environment
• Free meals!
• Company stock purchase discount
• Employee Assistance Program

• Bachelor's degree in human services;
  Master's degree in human services preferred.
• Three to five years of experience in utilization review and case management.
• RN, LCSW, LPC, LMFT, or LCP in Virginia required.
• Basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.
• Must know how to gather and analyze…