Position Summary:

The Director of UM and Admissions is a senior-level leader responsible for overseeing and coordinating all functions related to patient admissions and utilization management at KCBM, a psychiatric hospital. This role serves as a key interface between referral sources, clinical teams, and payers to ensure timely, appropriate, and cost-effective access to inpatient behavioral health services. The Director ensures that admissions are clinically appropriate and aligned with payer requirements, while promoting optimal patient care, throughput, and financial performance.

Key Responsibilities:

Admissions & Access Coordination:

• Direct and manage the 24/7 intake and admissions team, ensuring timely response to referral inquiries and patient assessments.
• Develop and implement protocols for screening, triage, and admission in accordance with clinical guidelines and regulatory standards.
• Collaborate with internal and external stakeholders (ERs, outpatient providers, law enforcement, etc.) to streamline the referral and admission process.
• Monitor key access metrics including admission turnaround time, referral conversion rates, and bed utilization.

Utilization Management:

• Oversee the utilization review (UR) process to ensure clinical documentation supports medical necessity for psychiatric admissions and continued stays.
• Coordinate peer-to-peer reviews with payers and provide leadership in appeals for denied days or services.
• Ensure timely authorization and reauthorization of services, working closely with managed care companies and third-party payers.
• Maintain current knowledge of payer guidelines and ensure compliance among clinical and UR staff.

Leadership & Strategy:

• Lead, train, and develop the admissions and UR teams, promoting a culture of accountability, excellence, and patient-centered service.
• Analyze trends and outcomes to inform process improvement strategies and optimize patient flow.
• Partner with senior leadership to forecast census, support bed management, and align staffing with service demand.
• Lead initiatives to reduce avoidable denials and improve the financial performance of inpatient services.

Compliance & Quality Assurance:

• Ensure that all activities are compliant with DNV, state regulations, and hospital policies.
• Participate in quality improvement initiatives and provide data-driven reports to senior leadership.
• Develop and maintain policies and procedures related to access and utilization management.

Qualifications:

Education & Experience:

• Registered Nurse, Social Work, Health Administration, or related field required.
• Licensure in a clinical field (RN, LCSW, LPC, etc.) preferred.
• Minimum of 5 years' experience in behavioral health admissions, access management, or utilization review, with 3 years in a leadership role.
• Experience in psychiatric hospital or acute behavioral health setting required.

Skills & Competencies:

• Deep understanding of psychiatric diagnosis, level of care criteria (e.g., MCG, InterQual), and payer requirements.
• Strong leadership and team-building skills.
• Excellent communication, negotiation, and decision-making abilities.
• Proficiency with EMR systems and utilization management software.

Working Conditions:

• Full-time, exempt position.
• On-call responsibilities as needed to support 24/7 operations.