Utilization Review Lead: Elevate Care & Compliance

Lake Charles Memorial Health System; Lake Charles (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

Lake Charles Memorial Health System is seeking a Utilization Review Supervisor to oversee daily department functions and staff, ensuring efficient utilization reviews and compliant documentation. The role requires nursing licensure, experience in acute behavioral health, and strong communication.

You will report to the Practice Manager and collaborate with leaders to reduce denials and improve patient care.

Qualifications

• Nurses with a behavioral health focus who can identify utilization patterns and support care improvements.
• Ability to interpret utilization data and communicate findings clearly.
• Experience ensuring medical necessity and stay criteria are met in records and reviews.
• Strong written and verbal communication with hospital teams and leadership.

Responsibilities

• Review patients' utilization records to identify patterns and improvement opportunities.
• Analyze utilization data to detect deficiencies and suggest care improvements.
• Ensure accurate and timely billing for services in the utilization process.
• Conduct utilization reviews per policies and procedures.
• Oversee daily claims filing corrections and documentation of stay criteria.

Skills

Communication skills

Critical appraisal

Interpersonal skills

Articulate observations

Education

Registered Nurse license (RN)

Crisis Response Training

CPR certification

Job description

Lake Charles Memorial Health System is seeking a Utilization Review Supervisor to oversee daily department functions and staff, ensuring efficient utilization reviews and compliant documentation. The role requires nursing licensure, experience in acute behavioral health, and strong communication.

You will report to the Practice Manager and collaborate with leaders to reduce denials and improve patient care.