Corporate Director of Intake and Utilization

Overview

The Corporate Director of Intake and Utilization Review is responsible for developing processes, monitoring performance, and improving the overall operation of the assessment, referral, and utilization review functions of the Voyages Behavioral Health network of hospitals to facilitate optimal financial and clinical outcomes.  In collaboration with executive leadership and key stake holders, this position will foster cross-functional and system-wide collaboration to ensure metrics are achieved and maintained. This is an exempt position and will require frequent travel (up to > 50% of the time).  

Responsibilities

Responsibilities

• Oversee and assists with individual hospital and system wide performance improvement in the areas of intake (assessment and referral) utilization review, outpatient and mobile assessment team.
• Ensures standardization throughout all Voyages Behavioral Health Hospitals.
• Creates guidelines for AR/UR staffing matrix for all hospitals, and includes divisional support, along with supporting justification/rationale.
• Reviews monthly performance indicators and reviews the improvement/action plans or processes to correct and improve performance and financial indicators.
• Oversees intake and UR infrastructure for new builds and acquisitions to assure compliance with CMS, TJC and State standards and successful opening.
• Recommends long-range plans for the AR and UR divisions to support Voyages Behavioral Health objectives
• Participates in educational activities and mentors hospital AR and UR leaders to ensure consistent levels of customer service and job proficiencies are attained.
• Plans and conducts departmental meetings at least monthly to keep employees informed about department, facility, and system to keep staff informed.

 Leadership

• Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others; demonstrates empathy; brings out the best in others and in his/her team.
• Managing Staff:  Coaches, evaluates, develops, and inspires staff. Sets expectations. Recognizes achievements. Effectively   manages conflict. Aligns dept. goals with company goals. Provides feedback, group leadership. Delegates appropriately.  Evaluations completed on time.
• Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources.   Appropriate understanding of confidentiality and company values. Adheres to and supports company policies, procedures and safety guidelines.
• Problem-Solving: Identifies problems, involves others in seeking solutions. Conducts appropriate analysis. Searches for best     solutions. Effectively and efficiently implements appropriate response to correct problem. Responds promptly and effectively to new challenges.
• Decision-Making: Makes clear, consistent decisions. Acts with integrity in all decisions. Distinguishes relevant from irrelevant information. Makes timely, appropriate decisions.
• Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly. Measures outcomes. Uses feedback to redirect as required. Evaluates alternatives. Appropriately organizes complex issues to desirable resolution.
• Communication: Connects with peers, subordinate employees and all customers. Actively listens. Clearly and effectively shares information. Demonstrates effective oral and written communication skills. Negotiates effectively.
• Quality Improvement: Strives for efficient, effective, high quality performance in self and the department. Delivers timely and accurate results. Resilient when responding to matters that are challenging. Takes initiative to make improvements.
• Leadership: Motivates others. Accepts responsibility. Maintains high morale in department. Develops trust and credibility. Expects honest and ethical behavior of self and staff.
• Teamwork: Encourages cooperation and collaboration. Builds effective teams. Works in partnership with others. Is flexible. Responsive to the needs of others.
• Development: Maintains up-to-date skills through involvement with professional organizations or continuing education.

Customer Service

• Maintains the highest level of customer service via courtesy, compassion and positive communication.
• Promotes the Mission and Vision of Voyages within the work environment and community.
• Respects dignity and confidentiality by adherence to all applicable policies and procedures.

Health and Safety

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.
• Participates in OSHA required training.
• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.
• Reports unsafe practices to management.
• Knows own role in case of an emergency.

Qualifications

Education and Training:  Masters Degree in nursing, social work, mental health/behavioral sciences, or related field required.  Current BLS certification required.  Crisis management certification per hospital policy and standards required. 

Experience:  Minimum of 5 years of progressive healthcare management experience required.

Knowledge, Skills, and Abilities: 

• Knowledge of CMS Conditions of Participation Guidelines for Discharge Planning, Utilization Review, Documentation, Medicare Important Message, Face to Face Requirements, and Patient Choice
• Knowledge of Medicare, Medicaid, and Managed Care Products and the requirements of each payer to meet the various levels of care for post-hospital services
• Knowledge of CMS guidelines and use of level of care determination for inpatient and observation, CMS inpatient only list and other payer guidelines as required
• Knowledge of nursing, standards based practice, shared governance, organizational initiatives, in terms of theories and practices to serve as a resource and educator to others
• Knowledgeable regarding InterQual criteria for utilization review; strong knowledge of InterQual Level of Care criteria
• Advanced knowledge of utilization management principles, concepts, and strategies including admissions criteria, levels of care, and denials
• Advanced knowledge of commercial insurances, Medicare, Medicaid, and State/Federal regulations which impact utilization management
• Understanding of and willingness to participate in budget preparation and fiscal management.
• Knowledge of in-patient admission criteria as they apply to appropriateness of admission.
• Demonstrable math skills to analyze and interpret financial/admission data and financial reports.
• Ability to understand and demonstrate computer operations and ability to reason through problems and errors.

About PAM Health

PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 80 locations, as well as wound clinics and outpatient physical therapy locations, in 17 states. PAM Health is committed to providing high-quality patient care and outstanding customer service, coupled with the loyalty and dedication of highly trained staff, to be the most trusted source for post-acute services in every community it serves. Its mission is to serve people by providing compassionate, expert care, and to support recovery through education and research. Joining our PAMily allows you to work in a collaborative environment with colleagues and leadership with exposure to a variety of patient care levels. Aside from our competitive pay, generous paid benefit time, and excellent insurance options, you will also have opportunities for professional growth through our Education Advancement Program. We are excited to learn more about you and hope that you consider joining us on a shared mission to improve the lives of others by being an integral part of our We Care Program. Please take a moment to visit us online at www.PAMHealth.com for a comprehensive look at how we're able to positively impact our local communities.

PAM Health does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person's actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.