Corporate Utilization Management Director

HEALING THE BODY AND MIND….

Founded fifteen (15) years ago, NeuroPsychiatric Hospitals is the largest hospital system in the nation providing care to patients with both neurological and medical needs.  We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues.  Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues.  This proven approach provides unrivaled quality care for all of our patients.  We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care. 

NeuroPsychiatric Hospitals is looking for a Corporate Utilization Management Director at our Corproate Office in Indiana. NPH is the national leader in providing medical and neurobehavioral care to patients in acute psychiatric distress. The Corporate Utilization Management Director is responsible for compliance with CMS Conditions of Participation regarding Utilization Review for the hospital system. The purpose of this position is to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.  Address the entire episode of illness through the use of care management plans, pathways and protocols.  Ensure that the hospital is reimbursed appropriately, decrease LOS and denials.

Benefits of joining NPH

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP) Programs
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart

• Utilization Management & Quality Care

  • Promote quality care through efficient and effective resource utilization, ensuring medical necessity of admissions, appropriate length of stay, and timely service delivery.
  • Oversee utilization review and case management programs, ensuring compliance with hospital policies and regulatory standards.
  • Implement and monitor InterQual and Milliman Care Guidelines to ensure appropriate levels of care.
  • Identify and address problematic Diagnosis Related Groups (DRGs), diagnoses, or procedures, recommending improvements to enhance outcomes.

• Care Coordination & Resource Optimization

  • Collaborate with physicians, nurses, and healthcare providers to ensure patients achieve expected outcomes within length-of-stay guidelines while reducing resource utilization.
  • Address the entire episode of illness using critical pathways, protocols, and care management plans.
  • Monitor documentation accuracy to ensure proper depiction of patient progress, taking corrective action when needed.
  • Develop and implement strategies to optimize reimbursement through accurate coding and documentation in collaboration with Medical Records and Finance.

• Leadership & Compliance

  • Provide leadership in coordinating hospital services, promoting effective care utilization, and managing healthcare resources.
  • Maintain current knowledge of regulatory and accreditation standards, ensuring compliance with federal, state, and hospital policies.
  • Educate staff on resource utilization policies, quality outcomes, and reimbursement processes.
  • Oversee certification of patient length of stay, working with insurance companies to ensure proper approvals.

• Performance Improvement & Reporting

  • Develop, implement, and evaluate initiatives to reduce length of stay, improve patient care quality, and ensure efficient resource management.
  • Conduct team meetings with nurses, physicians, social workers, and nutritionists to address case management and utilization review concerns.
  • Prepare and analyze reports on denial management, utilization trends, and performance metrics.
  • Represent case management functions in hospital committees, community councils, and workgroups focused on utilization management and performance improvement.

• Discharge Planning & Risk Management

  • Identify and address discharge planning issues, collaborating with appropriate staff to ensure smooth patient transitions.
  • Implement guidelines to ensure the completeness, validity, and reliability of patient discharge information.
  • Maintain up-to-date knowledge of occurrence screening methodologies and risk management policies.

• Corporate Compliance & Ethics

  • Adhere to NPH’s Corporate Compliance Policy, Code of Conduct, and Conflict of Interest Policy.
  • Stay informed of changes in regulations, laws, and hospital policies, ensuring ongoing compliance.

• Education:

  • Bachelor’s Degree required in a healthcare-related field; Master's degree preferred.

• Licensure/Certification:

  • Current Nurse Licensure preferred.
  • Case Management certification preferred.

• Experience:

  • Minimum of 5 years of utilization review experience in a hospital setting required.
  • 5 years of case management experience, including discharge planning in a hospital setting, preferred. 

• Skills & Knowledge:

  • Ability to work independently and collaboratively in a team environment.
  • Strong analytical skills, including patient care methodologies, criteria development, and data analysis.
  • Ability to prioritize tasks and adapt to a changing workload.
  • Proficiency in abstracting data for medical committee presentations in a professional manner.
  • Strong problem-solving and research skills, with knowledge of case management principles and critical pathways.
  • Deep understanding of regulatory and accreditation standards (e.g., HFAP, JCAHO) and laws related to Case Management, Utilization Management, and Risk Management.
  • Familiarity with hospital policies, medical staff bylaws, and community resources.
  • Proficiency in Microsoft Office Suite, email, and personal computing.
  • Excellent communication skills in both oral and written English.
  • Commitment to patient privacy and confidentiality.
  • Ability to establish and maintain effective relationships with physicians, staff, medical records personnel, social workers, patients, and the general public.