Anthony W. Deveraux
Ridge Behavioral Health Systems of UHS
GEORGETOWN
24
years of professional experience
Dynamic Director of Utilization Management with expertise in data analysis and process improvement. Proven track record in optimizing patient care and resource allocation while mentoring staff to enhance team performance. Skilled in leading interdisciplinary teams to ensure documentation accuracy and compliance, driving initiatives that improve patient outcomes and operational efficiency.
Work History
Director of Utilization Management
11 Years 4 Months- Supervised daily operations of clinical review processes, ensuring compliance with regulatory standards.
- Reduced hospital readmissions by identifying trends in patient care and recommending targeted interventions.
- Boosted appeal success rate to 44% to optimize financial recovery efforts, totaling $72,000 year-to-date.
- Implemented strategies to maintain a 2% denial rate, supporting operational efficiency in Kentucky UHS market.
- Achieved 97% initial authorization accuracy to eliminate coverage denials.
- Implemented strategies for improved documentation and collaborative efforts with physicians to decrease denial occurrences.
- Engaged with commercial Medicare and Medicaid managed care payers to define medical necessity criteria, ensuring compliance and efficiency.
- Coordinated efforts with healthcare providers to ensure patients met discharge goals, resulting in improved average length of stay metrics.
- Developed training programs for staff on utilization management best practices and procedures.
- Analyzed data trends to identify areas for improvement in service delivery and efficiency.
- Collaborated with interdisciplinary teams to enhance patient outcomes and streamline workflows.
- Managed high-profile cases effectively, ensuring timely resolution of complex utilization issues for patients, providers, and payers.
- Reviewed patient medical records for admission appropriateness and ongoing stay necessity, facilitating discussions with multidisciplinary teams on quality improvement initiatives.
- Built strong relationships with external stakeholders such as hospitals, clinics, provider networks, and insurance carriers to facilitate seamless coordination in service delivery.
- Implemented quality assurance measures to maintain high standards in utilization reviews.
Intake Dayshift Supervisor
5 Years 9 Months- Implemented and enforced EMTALA guidelines alongside hospital regulations to safeguard patient rights and care standards.
- Oversaw high-acuity psychiatric evaluations, suicide risk assessments, and level-of-care determinations, ensuring clinical accuracy for patient care.
- Directed real-time bed management and census tracking in close coordination with administration and nursing leadership to maximize facility capacity.
Intake Assessment Clinician
2 Years 5 Months- Executed thorough assessments to evaluate patient needs and communicated findings to on-call providers for care level determination.
- Worked closely with families, outpatient providers, referral sources to ensure risk stratification and well informed clinical decisions.
- Facilitated mentorship for new clinicians, offering guidance on techniques, documentation standards, and ethical considerations in practice.
Outpatient Therapist
4 Years 8 Months- Performed psychological assessments and compiled detailed summaries of findings to support clinical decision-making.
- Implemented evidence-based therapeutic interventions to facilitate client progress and recovery.
Education
Master of Science - Clinical Psychology
Bachelor of Arts - Psychology
Skills
Utilization review
Healthcare regulations
Case management proficiency
Data analysis
Process improvement strategies
Process improvement
Multitasking and organization
Attention to detail
Problem-solving
Timeline
Director of Utilization Management
Ridge Behavioral Health Systems of UHS
03.2015 - CurrentRead More
Intake Dayshift Supervisor
Ridge Behavioral Health Systems of UHS
06.2009 - 03.2015Read More
Intake Assessment Clinician
Ridge Behavioral Health Systems of UHS
01.2007 - 06.2009Read More
Outpatient Therapist
Pathways
05.2002 - 01.2007Read More
Morehead State University
Master of Science from Clinical Psychology
Read More
University of Kentucky
Bachelor of Arts from Psychology
Read More