Director Of Utilization Management (Um) And Performance Improvement (Pi) In Psychiatry

Position Overview: As the Director of Utilization Management (UM) and Performance Improvement (PI) in Psychiatry, you will play a crucial role in overseeing and optimizing the utilization of psychiatric services while ensuring high-quality patient care delivery. Your responsibilities will encompass managing utilization processes, implementing Performance Improvement initiatives, and collaborating with multidisciplinary teams to enhance efficiency and effectiveness within the psychiatric department.

Key Responsibilities:

• Utilization Management (UM):
• Develop and implement UM strategies to ensure appropriate utilization of psychiatric services, including inpatient, outpatient, and emergency psychiatric care.
• Oversee the utilization review process, including pre-authorization, concurrent review, and discharge planning, to optimize resource allocation and patient outcomes.
• Collaborate with clinicians, case managers, and insurance providers to facilitate timely approvals and resolve utilization-related issues.
• Performance Improvement (PI):
• Lead the development and implementation of PI initiatives aimed at enhancing the quality, safety, and efficiency of psychiatric care delivery.
• Establish performance metrics, benchmarks, and data analysis methodologies to monitor and evaluate clinical outcomes, resource utilization, and compliance with regulatory standards.
• Identify areas for improvement, conduct root cause analyses, and formulate action plans to address deficiencies and promote continuous quality improvement.
• Interdisciplinary Collaboration:
• Work closely with psychiatrists, psychologists, social workers, nurses, and other healthcare professionals to streamline care coordination and optimize patient flow throughout the continuum of psychiatric care.
• Foster a culture of collaboration, communication, and shared accountability to achieve common goals related to Utilization Managementand Performance Improvement.
• Regulatory Compliance:
• Ensure compliance with relevant regulatory requirements, accreditation standards, and payer guidelines governing Utilization Management, documentation, and quality reporting in psychiatric settings.
• Stay abreast of changes in healthcare regulations and industry best practices, and update policies, procedures, and workflows accordingly.
• Staff Education and Training:
• Provide education and training to clinical and administrative staff on UM principles, PI methodologies, documentation standards, and compliance requirements.
• Foster a culture of continuous learning and professional development to enhance staff competency and engagement in quality improvement efforts.

Qualifications:

• Master's or Doctoral degree in Healthcare Administration, Business Administration, Nursing, Psychology, or related field.
• Minimum of 5 years of progressive leadership experience in healthcare management, with a focus on Utilization Management, Performance Improvement, or psychiatric services.
• Strong knowledge of psychiatric care delivery models, treatment modalities, and regulatory requirements.
• Demonstrated expertise in utilization review processes, performance measurement, data analysis, and quality improvement methodologies.
• Excellent communication, interpersonal, and leadership skills, with the ability to collaborate effectively with diverse stakeholders.
• Certification in Healthcare Quality (e.g., CPHQ) or Utilization Management (e.g., CPUM) preferred.

Job Type: Full-time

Pay: Up to $135,000.00 per year

Benefits:

• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift

Ability to Relocate:

• Richmond Hill, NY 11418: Relocate before starting work (Required)

Work Location: In person