Yale New Haven Health System

  • MANAGER ADMISSIONS & UTIL MG

    Job Locations US-CT-New Haven
    Job ID
    65942
    Department
    UTILIZATION REVIEW DEPARTMENT
    Category
    MANAGEMENT/LEADERSHIP
    Position Type
    Full Time Benefits Eligible
    Scheduled Hours
    40
    Work Schedule
    DAYS
    Work Days
    MON-FRI
    Work Hours
    8:30AM - 5:00PM
    Work Shift
    SOME EVENING AND WEEKEND SHIFTS REQUIRED
    Requisition ID
    2018-19053
  • Overview

    To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

    The Manager of Admissions and Utilization Management is responsible for managing and optimizing the admissions and utilization management functions of Yale New Haven Hospital's Psychiatry and Behavioral Health services. The Manager is directly responsible for the admissions and utilization management of six inpatient units, six ambulatorysites, an observation unit, and two psychiatric emergency units at Yale New Haven Hospital. In addition, the Manager leads efforts to coordinate psychiatric transfers between Yale New Haven, Bridgeport, Greenwich, andLawrence + Memorial Hospitals. The position reports directly to the Assistant Director of Operational Finance for Psychiatry and Behavioral Health.


    EEO/AA/Disability/Veteran

    Responsibilities

    • 1. Management of Staff

    •     1 .1 Directly manage ten to fifteen admissions and utilization coordinators

    •     1 .2 Develop and routinely evaluate staffing patterns and schedules to ensure adequate coverage of all

                 services during days, evenings, weekends, and holidays.

          1 .3 Recruit, select, and hire staff as needed. Facilitate the training of new staff. Monitor departmental

    •            growth and create business plans that will increase staff size to accommodate service area needs .

          1 .4 Set objectives, manage performance, and conduct annual reviews for staff. Address performance issues

                 in a timely manner and provide or recommend training as needed.

          1 .5 Additional Management Responsibilities.

       

    • 2. Yale New Haven Admissions

          2 .1 Ensure psychiatric admissions take place in a timely manner in accordance with hospital policies and

                 procedures.

          2 .2 Drive attainment of inpatient bed utilization and patient flow targets.

          2 .3 Escalate admission issues and coordinate with medical director, attending physicians, charge nurses off-shift nurse leaders, and emergency department staff as needed

    •     2 .4 Develop inpatient admissions algorithms to effectively prioritize and admit patients based on diagnosis, wait time, and other factors.

    •     2 .5 Monitor effectiveness of admissions algorithms and modify as needed.

    •     2 .6 Review monthly reporting of average daily census to identify trends and opportunities to improve admissions process.

    •     2 .7 Provide admissions capabilities during night shift if other staff are not available.

    • 3. Central Admissions

    •     3 .1 Establish processes and relationships to facilitate the transfer and admission of Psychiatric and

                Behavioral Health patients between all hospitals within Yale New Haven Health System.

          3 .2 Develop and publish monthly reports of referral sources, transfers, direct admissions, ED cases, and

                other relevant metrics.

          3.3 Run monthly Central Admissions workgroup meetings to foster communication and drive continuous

                improvement.

    • 4. Utilization Management

    •     4 .1 Monitor and confirm that all pre-certifications, concurrent reviews, Interqual reviews, and discharge

                 notifications are completed in a timely manner.

          4 .2 Ensure that clinical denials are appropriate documented in electronic medical record and that

                responsible UM staff members address denials in a timely manner .

          4 .3 Promptly notify appropriate staff if prior authorizations or ongoing authorizations cannot be obtained.

          4 .4 Act as a consultant to clinical leadership on Utilization Management issues.

             5. Denials Management

                 5 .1 Analyze provider liable reports on a monthly basis and communicate relevant denial information to UM

                        staff.

                 5 .2 Conduct regular denials / revenue cycle meetings with ambulatory staff and other stakeholders as

                        requested to drive reductions in denials.

                 5 .3 Collaborate with the System Business Office, Patient Financial Services, Managed Care Contracting,

                       and other groups to minimize denials.

                 5 .4 Directly oversee and/or drive the resolution of high-value denials.

                 5 .5 Prepare responses to RAC and other audit inquiries.

     

     

             6. Process Improvement, Special Projects, and Strategic Initiatives

     

     

     

    Qualifications

    EDUCATION

     

    Bachelors degree required. Masters degree in social work, counseling, substance abuse, or marriage and family therapy beneficial but not required

     

    EXPERIENCE

     

    Minimum of seven (7) years experience in Utilization Management, with preference given to relevant experience in a behavioral health or substance abuse setting. Prior supervisory or managerial experience required.

     

    SPECIAL SKILLS

     

    Knowledge of acute and sub-acute psychiatric treatment modalities, psychiatric diagnoses, and their behavioral health utilization review and appeals procedures. Ability to gain credibility with clinical and administrative team as a subject matter expert in utilization management and admissions. Excellent oral and written communication skills , with the ability to communicate effectively with multiple disciplines and skill levels. Ability to effectively summarize and present information to stakeholders and senior management. Ability to manage and develop staff. Ability to set

    appropriate objectives, develop relevant metrics, and monitor outcomes on an ongoing basis. Strong analytical and problem solving skills. Proficiency with Excel, Word, and PowerPoint. Experience with an EMR required ; experience with Epic highly preferred. Ability to learn new software quickly. Ability to provide clinical /financial education to colleagues, patients and families. Collaborative and able to work effectively in a matrixed environment with other supporting departments. Knowledge of hospital revenue cycle processes, especially denials and appeals. Highly motivated to improve patient outcomes and drive improved financial results.

     

     

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