Director of Utilization Review/Case Mgt

Freedom Behavioral Hospital of Monroe; Monroe (LA); On-site; USD 45,000 - 65,000; Full time

Job summary

Freedom Behavioral Hospital of Monroe is seeking an Utilization Review representative to assess patient data, determine medical necessity, and coordinate discharge planning. The role involves reviewing admissions, treatment plans, and length of stay to ensure compliance with governmental and insurer requirements.

Preferred backgrounds include psychology or nursing education, and current nursing or social work licensure.

Qualifications

• 1+ year coordinating utilization review and discharge planning activities
• Education preferred in psychology or nursing
• Licensure as a Nursing or Social Worker professional
• Strong verbal and written communication skills
• Good organizational and analytical abilities
• Proficient PC skills and ability to follow written/verbal instructions
• Basic understanding of DSM V and medical/psychiatric diagnoses

Responsibilities

• Review and authorize precertification requests for medical necessity
• Analyze patient records to determine admission legitimacy, treatment, and length of stay
• Coordinate with Case Management/Social Services and refer to medical director when needed
• Support concurrent reviews and appropriately extend length of stay when justified

Skills

Verbal communication

Organizational skills

Interpersonal skills

Analytical reasoning

Reading comprehension

PC literacy

DSM V knowledge

Medical/psychiatric knowledge

Education

Psychology major preferred

Nursing education

Job description

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.