Project Intake & Utilization Director

Overview

PURPOSE STATEMENT:

 

Extensive Travel Is Required

 

The Project Intake and Utilization Director provides onsite leadership, direction, assistance, and acts as the interim Director to all assigned Acadia facilities in the area of Utilization Management. The Project Intake & UM Director identifies root causes and trends for adverse Intake and Utilization denial expense outcomes.   Collaborates and coordinates with corporate operations and clinical partners to optimize reimbursement outcomes. The Corporate Intake  & UM Project Director collaborates and coordinates with corporate operations and clinical partners to optimize reimbursement. Travel is required for this role up to 100% of time.

 

ESSENTIAL FUNCTIONS:

 

The Intake and UM Project Director collaborates with clinical services to ensure clinical documentation provides rationale to ensure authorization is obtained via a  successful utilization process. The Project UM Director’s focus on UM includes process, challenges, and outcomes as it pertains to ongoing authorization, denial and appeal management and prevention, payer analysis, data metric collection and strategic planning based on the data collected.

 

Provides on-site leadership to assess and analyze current Intake and Utilization processes, challenges and outcomes; including compliance and regulatory requirements are met.

Will Supervises onsite facility UM Department of assigned facility and completes all UM Director duties while on assignment.

Performs facility audits of clinical and financial information related to denial management including length of stay, medical necessity documentation, precertification, concurrent authorizations, compliance with Medicare Certification/Recertification, Medicare Internal Audits, and compliance with EMTALA standards.

Collaborates with clinical services to ensure clinical documentation provides rationale to ensure authorization is obtained and successful utilization of the patient’s individualized benefit is achieved.

Responsible for completion of monthly Denial meetings and quarterly UM committee meetings per Acadia policy. Determines causation and trends for upfront denials, concurrent review denials, and failed appeals, providing written findings and recommendations for process improvement. 

Guides action and implementation of programs to address deficiencies.

Ensures UM Department is following Acadia UM Standard Operating Procedures.

Works in cooperation with all division leaders to ensure that facility financial operations efforts are maximizing reimbursements while reducing unfunded days.

Provides consultation and guidance regarding written level of care guidelines for a variety of payors.

Provides consultation and guidance regarding the appeal process. Assists facility UM staff in creating effective appeal letters.

Ensures proper use of Medhost, the Medhost dashboard, and Sharepoint.

Maintains current knowledge of applicable regulations and regulatory update in the behavioral health field.

Evaluates the facility interface between Admissions/Intake, UR, Clinical, Business Office, and Marketing. Identifies opportunities for improved partnerships and outcomes for the facilities.

Evaluate and implement work-flow processes with Intake/Admissions, Utilization Management and Business Office.

Complete Medicare, Medicaid and commercial Audit Appeals for facilities.

 

STANDARD EXPECTATIONS:

• Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality.
• Communicate clearly and effectively to person(s) receiving services and their family members, guests and other members of the health care team.
• Develops constructive and cooperative working relationships with others and maintains them over time.
• Encourages and builds mutual trust, respect and cooperation among team members.
• Maintains regular and predictable attendance.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Bachelor’s degree in Nursing or other clinical degree.
• At least 5 years’ Supervisory experience in Intake and Utilization Management/Review or Case Management.
• Good knowledge of payor clinical guidelines; experience writing appeal letters.
• Significant behavioral healthcare experience in a variety of settings.
• Knowledge of insurance billing requirements.
• Effective and accurate oral and written communication skills.
• Knowledge of office administration procedures with the ability to operate most standard office equipment.
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