Healthcare Utilization Review Lead

Socket.dev; Lafayette (IN); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health (Medical, Dental, Vision) and 4

401K Benefits

Paid Time Off

Employee Assistance Program

Tuition Reimbursement/Assistance

Job summary

Sycamore Springs is seeking an experienced Utilization Review Manager to oversee the UR department, ensuring accurate precertification, recertification, and appeals processes for inpatient and outpatient services. The role collaborates with finance, clinical teams, and external payers to maintain compliant and timely reviews.

Essential functions include leading staff, coordinating peer-to-peer reviews, documenting coverage decisions, and reporting denial statuses to the Director of Finance.

Qualifications

• Bachelor’s degree required; Master’s degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Leadership experience required.
• Current unencumbered clinical license strongly preferred.
• CPI and HWC certification required.

Responsibilities

• Oversees the UR department, ensuring staff have completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the Director of Finance or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with clinical services team to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

Skills

Utilization review

Leadership

Education

Bachelor’s degree

Master’s degree

Job description

Sycamore Springs is seeking an experienced Utilization Review Manager to oversee the UR department, ensuring accurate precertification, recertification, and appeals processes for inpatient and outpatient services. The role collaborates with finance, clinical teams, and external payers to maintain compliant and timely reviews.

Essential functions include leading staff, coordinating peer-to-peer reviews, documenting coverage decisions, and reporting denial statuses to the Director of Finance.