Utilization Review Lead: Denials & Care Optimization

Lake Charles Memorial Hospital; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Lake Charles Memorial Health System is seeking an experienced Utilization Review Supervisor to oversee day-to-day operations of the UR team. You will guide staff, review records for patterns, and drive efficiency, reductions in denials, and adherence to policies.

The role requires a Bachelor's degree, at least five years in utilization review or related healthcare functions, and strong communication skills to articulate findings and collaborate with the Director of Psychiatric Services.

Qualifications

• Bachelor's degree in a related field or equivalent work experience required.
• Minimum of 5 years of experience in utilization review medical claims or related healthcare functions required.
• Demonstrated knowledge of the utilization review of departmental processes workflows policies procedures and the documentation standard required.
• Ability to articulate observations and utilization management needs in a clear and concise manner.
• Excellent communication and interpersonal skills.

Responsibilities

• Review patients' utilization records to identify patterns and make recommendations for improvement.
• Review patient utilization data trends and patterns to identify areas of deficiency and suggest strategies to improve patient care.
• Review patients' utilization records to ensure accurate and timely billing for services provided.
• Conduct utilization reviews in accordance with policies and procedures.
• Review the daily held claims report and oversee correction of filing claims.
• Oversee documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
• Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
• Oversee all utilization review and management activities in psychiatric services and report findings to Director of Psychiatric Services.

Skills

Communication skills

Interpersonal skills

Education

Bachelor's degree in a related field or equivalent

Job description

Lake Charles Memorial Health System is seeking an experienced Utilization Review Supervisor to oversee day-to-day operations of the UR team. You will guide staff, review records for patterns, and drive efficiency, reductions in denials, and adherence to policies.

The role requires a Bachelor's degree, at least five years in utilization review or related healthcare functions, and strong communication skills to articulate findings and collaborate with the Director of Psychiatric Services.