Utilization Review Manager

Socket.dev; Lafayette (IN); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health (Medical, Dental, Vision) and 4

401K Benefits

Paid Time Off

Employee Assistance Program

Tuition Reimbursement/Assistance

Job summary

Sycamore Springs is seeking an experienced Utilization Review Manager to oversee the UR department, ensuring accurate precertification, recertification, and appeals processes for inpatient and outpatient services. The role collaborates with finance, clinical teams, and external payers to maintain compliant and timely reviews.

Essential functions include leading staff, coordinating peer-to-peer reviews, documenting coverage decisions, and reporting denial statuses to the Director of Finance.

Qualifications

• Bachelor’s degree required; Master’s degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Leadership experience required.
• Current unencumbered clinical license strongly preferred.
• CPI and HWC certification required.

Responsibilities

• Oversees the UR department, ensuring staff have completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the Director of Finance or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with clinical services team to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

Skills

Utilization review

Leadership

Education

Bachelor’s degree

Master’s degree

Job description

Your experience matters

At Sycamore Springs,we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program – mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

About Us

People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone—your experience matters

How you’ll contribute

The responsibility of the UR Manager is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Manager will report consistently and accurately to the Director of Finance the authorization status of current patients and appeals.

Essential Functions:

• Oversees the UR department, ensuring staff has completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the Director of Finance or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with clinical services team to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

Qualifications and requirements

Education: Bachelor’s degree required. Master’s degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred. Leadership experience required.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPI and HWC certification required.

EEOC Statement

Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.