Utilization Management Director jobs in Anderson, SC

Who We Are

The Carolina Center for Behavioral Health is a 156-bed private behavioral health system located on 13 acres in the Greenville, South Carolina Area. Specializing in psychiatric programs and substance abuse treatments such as detox and rehab, The Carolina Center serves Greenville, Spartanburg, Anderson, and areas throughout South Carolina and western North Carolina. Programs are available at various levels of care to accommodate the severity of every patient’s condition: inpatient, partial hospitalization, and intensive outpatient treatment. To learn more visit: https://thecarolinacenter.com/.

Who You Are

It’s the opportunity to make a difference that drives you. It's taking the time to really listen to a patient so you can do your best to help. It's the camaraderie among professionals who push you further than you ever thought you could go. You are as equally diligent and attentive during quiet times as you are in a crisis situation. You are a highly empathetic individual with a high level of emotional and social intelligence. Your satisfaction comes from a patient’s noticeable progress or a sincere word of thanks from your patient's family. It's these experiences that solidify your dedication to helping others.

The Director of Risk Management assists with the coordination of the risk management program functioning as an objective body that reviews and evaluates issues/concerns within the organization. The Director of Risk Management is involved in processes to help protect the hospital's assets from loss. Working closely with the Director of Quality Assurance, the Director of Risk Management is responsible for coordinating the loss control efforts and for making recommendations to minimize or eliminate exposure. The structure and functions of the Risk Management Program are designed so as to comply with guidelines and standards of The Joint Commission, other regulatory agencies, and the UHS T.E.R.M.© Program. Actively serves as a key member of the organization’s core management team.

RISK IDENTIFICATION & EVALUATION

• Ensures appropriate and timely reporting of occurrences by maintaining a Healthcare Peer Review Reporting system. (Occurrence notification system); enters incidents into the MIDAS Database.
• Collects and screens all reports.
• Identifies actual and potential risk situations and facilitates the determination of causative factors.
• Refers occurrences for follow up to appropriate department or medical committee; ensures that all Level III/IV are referred to the Peer Review Committee.
• Develops and oversees staff schedule that meets patient’s needs.
• Receives immediate and concurrent reporting of adverse patient outcomes identified by the PI process.
• Performs risk surveys and inspects patient care areas in concert with hospital's safety (EOC) program committee objectives.
• Receives and investigates reports of product problem to determine appropriate response and establish record keeping responsibilities. In the event of patient injury, established direction from the Director of Quality Assurance and Corporate Risk Management in the appropriate action for defense strategy.
• Receives information (verbally or formally on the HPR) from facility staff regarding patient events which may lead to a claim.
• Reviews reports on facility and equipment to assess loss potential.

RISK REDUCTION

• Networks with department managers to implement system changes aimed at optimally reducing or eliminating causative factors.
• Networks with medical staff to ensure active involvement and participation in:
• Risk identification
• Risk analysis
• Risk reduction/loss prevention problem solving and program development designed to benefit the clinical aspects of patient care and safety.
• Interfaces with the Patient Advocate specific to patient complaints and assesses/recommends action, on those, which may be a source of potential litigation.
• In conjunction with hospital administration recommends actions when possible to resolve with patient and/or family any grievances against hospital perceived as potential liability claims.
• Identifies particular practices having legal connotations to target planning of preventive and corrective measures.
• Assesses liability and probability of legal action.
• Participates actively in committees including identifying trends for group action and participates in Environment of Care walk-through.

CLAIMS MANAGEMENT

• Facilitates the processing of summons and complaints served on the hospital and its employees.
• Reports receipt of summons and complaints immediately to Corporate Risk Management and Insurance Department.
• Assists the Corporate Risk Management as needed to intervene, document and assist in the investigation of all claims.
• Coordinates investigation of claims within the facility
• Directs in house claims investigation.
• Preserves all pertinent information (medical record, equipment, lab/pathology specimens, relevant reports and policies and procedures)
• Facilitates early reporting
• Establishes early control of situation
• Assists in obtaining materials for attorneys
• Maintains all legal case files and ensures maximum protection and discoverability
• Coordinates with and assists attorneys as they interface with the facility and employees.
• Advises Business Office of actions consistent with directions from Corporate Office for unpaid accounts involved in litigation.
• Coordinates legal activities and local counsel including interviews and production of discovery.

REPORTING, REPORT PREPARATION, & SUBMISSION

• Provides aggregate analysis of risk data and trend analysis of incidents to: Administration, Corporate Risk Management, Patient Safety Council, MEC, Performance Improvement, Environment of Care/Safety Committee, Governing Board, and Medical Staff Committees/Departments as necessary, and related to the department.
• Incidents with Claims Potential. Reports to Corporate RM any serious risk event involving actual or potential injury to patients and visitors; enters PCR’s (Level III/IV incidents) into STARS Database within 10 business days of the incident.
• Coordinates Patient Safety Council. Reports Risk Management activities to the Quality Council and Medical Executive Committee.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education/Licensure: Prefer a Master’s Degree in Healthcare Management or a related field, or the minimum must be a Registered Nurse.

Experience: Five years clinical experience with knowledge of high-risk areas.

Additional Requirements: This position must be very familiar with Joint Commission, State and Federal standards and regulations. Also, must have excellent organizational skills, and be able to maintain reports and policies and procedures. Must have excellent communication skills that include the ability to interact with and coordinate all levels of staff.

Physical and Mental Requirements of the Job:

Possible exposure to psychiatric patients who may exhibit violent/aggressive behavior; potential exposure to communicable diseases, blood/body fluids and, other hazardous waste. Ability to exercise self-control in potentially volatile situation such as being verbally or physically confronted in a threatening or aggressive manner. Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic. Ability to handle interruptions often and be able to move from one task to another. Must be flexible and not easily frustrated in dealing with differences of opinions. Able to assist in patient restraints and seclusions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to have full range of mobility in upper and lower body; be able to reach overhead; be able to work in various positions, including stooping, standing, bending over, sitting, kneeling and squatting for extended periods of time; be able to lift, pull and push materials and equipment to complete assigned job tasks; and be able to frequently lift 20 pounds of weight throughout the assigned workday.

Ability to express and exchange ideas via spoken language or important spoken instructions to others accurately, sometimes quickly and loudly. Hearing to perceive sound with no less than 40 db loss @ Hz,1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information through oral communication and to make fine discriminations in sound. Perform repetitive motions with wrists, hands and fingers. Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks and visually observe patients on the unit and in therapeutic activities. While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.

UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS" or "UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we," "us," "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including UHS of Delaware, Inc.

All employment at “UHS” is with one of the subsidiaries of Universal Health Services, Inc., including its management company, UHS of Delaware, Inc. Universal Health Services is a holding company.

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Education:

• Master's (Preferred)

Experience:

• Risk Management: 5 years (Preferred)

License/Certification:

• South Carolina RN License (Preferred)

Ability to Relocate:

• Greer, SC 29650: Relocate before starting work (Required)

Work Location: In person