Strategic Utilization Review & Case Management Professional

Freedom-Behavioral-Hospital-of-Monro; Monroe (LA); On-site; USD 50,000 - 65,000; Full time

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Verbal communication

Organizational skills

Analytical problem solving

Reading comprehension

Education

Psychology major or nursing education

Tools

PC computers

Job description

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