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