Utilization Management Supervisor: Compliance & Denials

Central Florida Behavioral Hospital; Orlando (FL); In loco; USD 65.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive compensation

Generous Paid Time Off

Medical, Dental, Vision plans

401(K) with company match

SoFi student loan refinancing

Tuition savings for nursing education

Career development opportunities

Pet Insurance

Benefits Guest Website

Descrizione del lavoro

Central Florida Behavioral Hospital in Orlando, FL is seeking an UM Supervisor to provide oversight for the staff and UR department under the direction of the Director, Utilization Management.

You will ensure clinical reviews meet continued authorization, uphold medical necessity standards, and oversee UR processes including denial appeals. Prior regulatory and inpatient behavioral health experience is valued.

Competenze

• Master’s degree required from an accredited college or university in social work, mental health related field or equivalent for licensure.
• A minimum of two (2) years' experience with communication with external review organizations in chart analysis and UR field required.
• Ability to work independently and set priorities.
• Valid FL license: RN, LSCW, LMHC, LMFT preferred.

Mansioni

• Ensure protocol for clinicians to review the patient’s medical record on specific days to meet continued authorization.
• Ensure knowledge of staff regarding medical necessity, regulatory requirements and standards, i.e. Joint Commission, Title 9, CMS/Medicare guidelines, EMTALA, HIPAA, etc.
• Oversee processes and procedures for all UR activities, including written appeal letters for denials

Formazione

Master’s degree in social work / mental health field

Descrizione del lavoro

Central Florida Behavioral Hospital in Orlando, FL is seeking an UM Supervisor to provide oversight for the staff and UR department under the direction of the Director, Utilization Management.

You will ensure clinical reviews meet continued authorization, uphold medical necessity standards, and oversee UR processes including denial appeals. Prior regulatory and inpatient behavioral health experience is valued.