[Hiring] Manager - Central Appeals Office @UHS

Role Description

BH Shared Services (a UHS company) located in Brentwood, TN is currently seeking an experienced Manager-Central Appeals Office to join our established team. This position will oversee all operations in all markets of the CAO and provide leadership and management to ensure overall quality, compliance, and timeliness occurs for all post-service appeals. This position must have at least five years’ experience in utilization management in either an in-patient psychiatric/substance abuse/rehabilitation setting and/or payer/managed care environment and three years of leadership experience.

Responsibilities:

• Leadership responsibility for all appeal inventory and productivity across all markets, ensuring timely completion of appeals.
• Serves as the primary liaison to facilities to maintain alignment and consistency in appeal operations.
• Assists with training and mentorship to the Market Appeals Specialist/ Appeals Support Specialist enhancing their understanding of appeal management principles and practices.
• Supports initiatives that drive performance improvement through technology advancements and expansion efforts in the division.
• Performs other duties as assigned/required by this position.

This opportunity provides the following:

• UHS offers a challenging and rewarding work environment.
• Growth and development opportunities within UHS and its subsidiaries.
• Competitive Compensation.
• Excellent Medical, Dental, Vision and Prescription Drug Plan.
• 401k plan with company match.
• Generous Paid Time Off.
• Gym and workout area.

Qualifications

• Bachelor's degree required, Master's preferred.
• Master's level clinician required, Licensure preferred.
• 5-8 years related experience required, 8-10 preferred.
• Ability to apply practice management guidelines to determine medical necessity and appropriateness of care for commercial and federal insurance plans.
• Subject matter expertise in overall management of the appeal and denial process – both from a clinical and administrative perspective.
• Clinical experience and an overall understanding of the internal operations of a behavioral health hospital.
• Strong interpersonal and communication skills—both written and verbal.
• Strong working knowledge of the health care industry and regulatory environment specifically in behavioral health.
• Proficient with word processing – including Excel, PowerPoint.

Requirements

• 5 years’ experience in utilization management.
• 3 years of leadership experience.

Benefits

• UHS offers a challenging and rewarding work environment.
• Growth and development opportunities within UHS and its subsidiaries.
• Competitive Compensation.
• Excellent Medical, Dental, Vision and Prescription Drug Plan.
• 401k plan with company match.
• Generous Paid Time Off.
• Gym and workout area.