Director of Utilization Management (UM) / Utilization Review (UR)

TMC Bonham Hospital

  • Moultrie, GA
  • Permanent
  • Full-time
  • 5 days ago
Job Description:ResponsibilitiesDirector of Utilization Review (UR) / Utilization Management (UM)Turning Point has an opening for a full-time Director of Utilization Review (UR) / Utilization Management (UM). The Director works closely with the Medical Office, Admissions/Intake, Nursing and Clinical departments to ensure quality of documentation of patient care. This important position implements and manages the Utilization Management Plan and identifies trends which impact service delivery for quality improvement.
  • Assures adherence to Accrediting and Regulatory Agency requirements maintaining records to ensure compliance.
  • Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
  • Coordinates all aspects of the hospital’s utilization review process to ensure that every patient receives quality care through utilization of adequate resources in the most cost-effective manner.
  • Performs admission and concurrent reviews of patients and assures optimum quality of care as part of treatment teams.
  • Supervises Utilization Review department ensuring continuing education and competency of staff.
Apply online atInterested in relocating to our community? Learn more about the city of Moultrie and Colquitt County here:;;Centrally located in South Georgia, our facility is 30 minutes from I-75, 1.5 hours north of Tallahassee, FL, 3 hours south of Atlanta, GA, and 2.5 hours west of Jacksonville, FL. Our employees reside in Moultrie or surrounding communities including Albany, Tifton, Thomasville, and Valdosta, GA.Join our team and discover a rewarding, fulfilling career.Turning Point Care Center, LLCFor more than 39 years, Turning Point Care Center has provided a place of healing and hope to adults who suffer from behavioral health disorders and/or substance abuse. We are committed to providing quality behavioral health care through our inpatient and outpatient gender specific programs in Moultrie, GA. Our serene, rural setting gives patients a secure environment where they can build their foundation for lifelong recovery. We believe in creating healthy communities, which start with healthy individuals, linked through sound relationships to their families, friends, neighbors and peers.Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Visit our website at https://turningpointcare.com to learn more.We offer a competitive and comprehensive benefits program including:
  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Flexible Spending Accounts
  • Health Savings Accounts
  • Short and Long Term Disability
  • 401K with match
  • Employee Stock Purchase Plan
  • and additional voluntary benefits and discounts. (Even Pet Insurance!!)
Additional benefit details provided at . Choose “I am a Guest” to view options designed to enhance and promote our employees’ health and wellbeing.Qualifications
  • Licensure through state composite board for nursing or counseling/therapy:
  • Minimum RN, LMSW, LAPC, LAMFT
  • Preferred BSN, MSN, LCSW, LPC, LMFT
  • Two (2) years of supervisory experience preferred.
  • Three (3) years of experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness
  • Knowledge and understanding of a variety of insurances including: Traditional Medicare, Medicare Advantage Plans, and Commercial Plans
  • Knowledge and experience with chemical dependency programs, mental health programs, situational evaluations, and crisis intervention, preferred.
This opportunity offers the following:
  • CEUs required for biannual licensure for Therapists (provided for free without having to use leave to attend)
  • Rewarding work environment
  • Growth and Development Opportunities within UHS and its 300+ Subsidiaries
  • Excellent Medical, Dental, Vision and Prescription Drug Plan
  • 401k plan with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
Apply online atAbout Universal Health ServicesOne of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.comEEO StatementAll 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.Avoid and Report Recruitment ScamsWe are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.Utilization Review, UR, Utilization Management, UM

TMC Bonham Hospital