Director of Utilization Review/Case Mgt

Freedom-Behavioral-Hospital-of-Monro; Monroe (LA); Vor Ort; USD 50.000 - 65.000; Vollzeit

Zusammenfassung

Freedom Behavioral Hospital of Monroe is hiring a Utilization Review representative. This role analyzes patient records, assesses admission legitimacy, and interprets data per governmental and insurer requirements.

Responsibilities include precertification review and collaboration with Case Management/Social Services to optimize patient care. The ideal candidate has a psychology or nursing background, 1+ year in utilization review, and strong verbal communication, organization, and analytical

Qualifikationen

• Background in psychology or nursing education preferred.
• Experience in utilization review or discharge planning a plus.
• Ability to interpret guidelines for medical necessity and admission criteria.
• Strong communication and organizational skills essential.

Aufgaben

• Review patient records to determine admission legitimacy and length of stay.
• Evaluate precertification requests for medical necessity and escalate as needed.
• Provide consultation to Case Management and Social Services as appropriate.
• Coordinate utilization review activities and document findings accurately.

Kenntnisse

Verbal communication

Organizational skills

Analytical problem solving

Reading comprehension

Ausbildung

Psychology major or nursing education

Tools

PC computers

Jobbeschreibung

Freedom Behavioral Hospital of Monroe has an immediate opening for a Utilization Review representative. At Freedom, we put patient care first in all we do, and our people make that possible. We know that your best work happens when you live your best life and share your unique talents. If fulfilling your career potential in an environment where you know you have made a difference in the lives of others sounds appealing, this is the job for you.

The Utilization Review representative provides appropriate care and assesses and interprets data based on the patient's status and the age specific needs of the individual. Analyzes patient records to determine legitimacy of admission, treatment, and length of stay to comply with governmental and insurance company requirements. This position is responsible for review of precertification requests for medical necessity, referring to the medical director those that require additional expertise. The Utilization Review representative will review clinical information for concurrent reviews, extending the length of stay for patients as appropriate and provide appropriate consultation and referral to Case Management/SocialServices personnel.

PREFERRED KNOWLEDGE, SKILLS, AND/OR EXPERIENCE REQUIRED:

• Education: A psychology major is preferred or nursing education
• License: Nursing License, Social Worker License or
• Experience: 1+ years coordinating utilization review and discharge planning activities
• Gerneral Requirements
• Effective verbal communication skills
• Effective organizational skills
• Effective interpersonal skills
• Analytical problem solving skills
• Ability to read and comprehend written instructions; ability to follow verbal instructions
• Proficient knowledge of PC computers
• Basic understanding of DSM V diagnostic criteria
• Basic understanding of medical and psychiatric diagnoses and conditions

****All Applicants selected for employment will be required to undergo a post-offer drug test and federal background investigation.