One of the nation's largest and most respected hospital management companies, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Steadily growing since its inception to an esteemed Fortune 500 corporation, UHS today has annual revenues of $10 billion and 83,000 employees. In 2018, UHS was recognized for the eighth consecutive year as one of the World's Most Admired Companies by Fortune; and in 2017, ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.
The Regional Manager- Utilization Management provides management, oversight and guidance to the hospital operation as it relates to utilization management and the overall market relationship with third party payers. Oversees all hospitals within a specific market or assigned areas to drive, sustain, develop and monitor not only the utilization management department, but also all the other hospital operations that ultimately support Utilization Management. Manages training, application of Medical Necessity Criteria, payer engagement, appeal letter inventory and quality/content, documentation, department partnerships (i.e. business office), clinical strategy (medical and nursing). Develops and oversees customized reimbursement strategies that align with the local market and hospital payment goals. In conjunction with the local team, this individual will support a corporate liaison role that will drive market strategy and accountability for the success of the utilization management program.
Essential Job Duties:
With the use of appropriate data sets, identifies market specific initiatives to assist/support/guide utilization review, as well as, all departments that affect utilization review. Includes identification of opportunities that would drive improvements in payer reimbursement, quality/content of the appeal process, clinical documentation and an overall proactive approach to the utilization review process.
Provides on-site hospital support for monitoring and evaluating the utilization review process.
Coordinates efforts with corporate departments (i.e. clinical, finance, quality, business office) to align with process improvements.