Utilization Review Manager

Harboroaks; New Baltimore (MI); On-site; USD 60,000 - 80,000; Full time

Job summary

An established industry player in mental health and addiction treatment is seeking a dedicated Utilization Review Manager. In this vital role, you will monitor service utilization, secure insurance authorizations, and ensure compliance with regulations. You will also provide leadership in staff management, fostering a collaborative environment to enhance patient care and optimize reimbursement processes. This position offers a unique opportunity to make a significant impact in the lives of patients while working in a supportive team. If you are passionate about mental health and want to contribute to a meaningful mission, this role is perfect for you.

Qualifications

• Current licensure as LPN, RN, LPC, LMSW, or LLMSW required.
• CPR and de-escalation certification needed.

Responsibilities

• Monitor service utilization and optimize reimbursement for patient benefits.
• Secure authorizations for inpatient treatment and manage patient stays.

Skills

Utilization Review

Patient Advocacy

Insurance Authorization

Clinical Documentation Review

Staff Management

Education

Licensure as LPN or RN or LPC, or LMSW or LLMSW

CPR Certification

Job description

Overview

Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team!

Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI.

Non-Exempt Position

PRN Position

Monday - Friday - Day Shift

Rate of Pay: $25.00 - $35.00 per hour (based on experience)

Responsibilities

PURPOSE STATEMENT:

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.

ESSENTIAL FUNCTIONS:

• Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
• Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
• Evaluate the utilization program for compliance with regulations, policies and procedures.
• Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

Qualifications

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• If applicable, current licensure as an LPN or RN or LPC, or LMSW or LLMSW within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
• First aid may be required based on state or facility requirements.

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