Director of Utilization Review/Case Mgt

Freedom Behavioral; Monroe (LA); On-site; USD 52,000 - 62,000; Full time

Job summary

Freedom Behavioral Hospital of Monroe seeks a Utilization Review representative to assess patient status, interpret data, and ensure compliance with governmental and insurer requirements. The role includes reviewing admissions, treatments, and length of stay as well as precertification requests and referral of complex cases to medical leadership.

Ideal candidates have 1+ years in utilization review or discharge planning, with strong communication and analytical skills, and the ability to work

Qualifications

• Psychology major preferred or nursing education.
• Nursing license or social worker license may be relevant.
• 1+ years coordinating utilization review and discharge planning activities.
• Post-offer drug test and background check required.

Responsibilities

• Review patient records to determine admission validity, treatment, and length of stay in line with governmental and insurer requirements.
• Evaluate precertification requests for medical necessity and refer complex cases to the medical director.
• Perform concurrent reviews and assess need to extend length of stay.
• Provide consultation and referrals to Case Management/Social Services as needed.

Skills

Verbal communication

Organizational skills

Interpersonal skills

Analytical problem solving

Education

Psychology major or nursing education

Tools

PC computers

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/Social Services 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.