Manager - Utilization Review

Acadia Healthcare; Conway (AR); On-site; USD 55,000 - 85,000; Full time

Job summary

Harboroaks is seeking a professional to monitor service utilization and optimize reimbursement while ensuring patient provider benefits are used effectively.

The role focuses on coordinating admissions, securing and maintaining authorizations, and overseeing a utilization program compliant with regulations. Leadership and staff management responsibilities are included.

Qualifications

• 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 and restraint certification required (training available upon hire and offered by facility).
• First aid may be required based on state or facility requirements.

Responsibilities

• 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 for duration of patient stay.
• Evaluate the utilization program for compliance with regulations, policies and procedures.
• Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
• Perform other functions and tasks as assigned.

Job description

Overview

PURPOSE STATEMENT:

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.

Responsibilities

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 for duration of patient stay.


• Evaluate the utilization program for compliance with regulations, policies and procedures.


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


• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

Qualifications

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• If applicable, 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 and restraint certification required (training available upon hire and offered by facility).


• First aid may be required based on state or facility requirements.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.