DIRECTOR CASE MANAGEMENT

Director of Case Management-FT Opportunity

West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and included a 16-bed residential treatment center for adult chemical dependency.

We offer a broad range of behavioral health programs for children, adolescents and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization and intensive outpatient. We are available 24 hours a day, seven days a week to assist you and answer your questions about treatment options and insurance coverage. The hospital is easily accessible off the Southwest Freeway near the Galleria.

Visit us online at: https://westoakshospital.com/

West Oaks Hospital is seeking a dynamic and talented full-time Director of Case Management to join our team of compassionate, dedicated professionals. The Director of Case Management will oversee patient care coordination, emphasizing efficient discharge planning and smooth care transitions in collaboration with interdisciplinary healthcare teams. The Director of Case management will monitor and analyze key metrics, preparing performance and quality reports for senior leadership to drive improvement initiatives. Serve as a liaison between clinical staff, patients, insurance providers, ensuring clear and supportive communication throughout care transitions.

Job Duties/Responsibilities:

• Evaluates charts concurrently at prescribed intervals, analyzes patient clinical information to determine patient length of stay, discharge criteria, length of stay, etc.
• Determines chart deficiencies in documentation. Follows through with appropriate staff as needed.
• Maintains records of chart reviews, actions and results.
• Monitors specific problems, trends and patient care issues.
• Assesses utilization review of services to determine over or under utilization of services. Presents finding and recommendations to treatment team.
• Receives authorizations, negotiates and advocates on behalf of the patient and hospital for patient coverage from insurance companies. Communicates authorizations through reports and treatment team to physicians and other staff.
• Serves as liaison between insurance companies, physicians and other clinical staff.
• Evaluates medical record and conveys clinical information to insurance companies and payors as authorized by patients. Negotiates with payors for care based on patient's severity of illness.
• Notifies physicians and clinical staff of documentation requirements and of identified chart deficiencies. Follows through as needed.
• Assesses clinical documentation in medical records to ensure that the master treatment plan goals and objective adequately meet quality standards.
• Ensures all documentation is clear, concise and complete to include provision of comprehensive treatment documentation according to regulatory and hospital standards.
• Analyzes and provides results of special and routine chart reviews and relevant data.
• Plans and assigns chart review activities to ensure consistent review at prescribed intervals.
• Attends treatment team meetings to discuss patients who are approaching a review.
• Prepares and organizes care for patient and hospital appeals in a thorough and timely manner.
• Communicates to physicians the need for prompt response in securing discharge summaries and appeal letters.
• Determines documentation required for the appeals process, assesses quality of all documentation and forwards to payor as required.
• Maintains current logs and records of denials and appeals
• Performs other duties as assigned.

Benefit Highlights:

• Student Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Requirements:

• Education Required: Bachelor's Degree in Psychology, Social Work, Nursing or related field. Preferred: Master's Degree.
• Licensure and certification required: CPR and hospital de-escalation certifications.
• Experience Required: Seven years of experience in utilization review management or related field. Preferred: Experience in a psychiatric setting.

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.

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