VP of Utilization Review and Case Management Details

VP of Utilization Review and Case Management

Lightfully Behavioral Health - Los Angeles, CA

Employment Type : Full-Time

Lightfully Behavioral Health is a growing leader in mental health treatment providing high-quality, evidence-based treatment and innovative, compassionate care focused on total wellness for those struggling with mental health conditions. Lightfully provides treatment on a full continuum of care including residential, partial hospitalization, intensive outpatient, and virtual services. With current communities providing best-in-class care in Southern California markets, Lightfully is positioned for dynamic and high-paced growth.

Welcome to a behavioral health services company unlike those that have come before it. One where leaders believe in the healing and nourishing quality of compassion both in treating clients and caring for our people. A safe place to bring your whole self to work and infuse a bit of your own magic into what you do every day. The Lightfully Shining Commitments reflect our commitment to these principles and encourages our staff to deliver exceptional performance through their authenticity, bravery, and grit. We believe that great things can happen when we create space for people to light fully.

Job Summary:

The Vice President of Utilization Review and Case Management supervises the UR specialists and creates systems for efficiency, growth, and improved outcomes (e.g., related to peer reviews, LOS). This position ensures that program guidelines are followed under all insurance network contracts, federal and state insurance commissions, as well as all accrediting bodies for all Lightfully Behavioral Health (LBH) locations. This position also supervises the Case Managers, who serve as the care coordinator and discharge planner for LBH clients.

Major Responsibilities:

• Oversees the work of UR Specialists and Case Managers. Hires, trains, and guides the professional development of team members.
• Provides supervision of UR staff and Case Managers to ensure that the UR process is appropriate for the clients, meets professional and ethical standards, and is effective.
• Creates and provides trainings and collaborates with regional teams to improve documentation, improve strategic decision making around LOS and peer reviews, and improve accuracy in discharge projections and discharge types.
• Coordinates with Admissions department regarding admissions, LOC determination, and precertification.
• Collaborates with National Director of Family and Support Services to support Case Managers in providing support group services.
• Develops systems and strategies for the UR department to improve efficiency and quality.
• Communicates with program level teams all critical information relating to issues of quality of care.
• Monitors updates in medical necessity criteria to ensure programs are meeting insurance requirements.
• Performs all other duties as assigned

Specific Skills/Competencies:

• Excellent management and supervisory skills.
• Excellent written and verbal communication skills.
• Excellent organizational and time management skills.
• Proficient in Microsoft Office Suite or similar software.

General Skills and Requirements:

• Able to communicate effectively in English, both verbally and in writing.
• Able to work for prolonged periods sitting at a desk and working on a computer.

Qualifications:

• Master's degree in counseling-related field or BSN
• 5+ years experience in Utilization Review
• 5+ years experience in leadership

This is an exciting opportunity to help us build something from the ground up. To be part of a dynamic team of passionate providers looking to create something exceptional and well timed in the market.