Manager-Utilization Management

ESSENTIAL FUNCTIONS:

Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.

Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations through ongoing clinical reviews until patient discharges from treatment.

Evaluate the utilization operation for compliance with mandatory policies and procedures.

Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.

Maintain efficient, positive customer service attitude towards patients, their families and co-workers while being responsive to customer needs.

May provide oversight and direction to utilization staff.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).

First aid may be required based on state or facility.

Experience

• 1 year(s): One or more years of supervisory experience required
• 4 year(s): Four or more year's clinical experience with the population of the facility

• 1 year(s): previous experience in utilization management preferred.

Education

• Bachelors or better in Psychology or related field
• Bachelors or better in Nursing/Healthcare or related field

Licenses & Certifications

• Reg Nurse
• Lic Practical Nurse

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)