Utilization Review Manager - Healthcare Quality & Appeals

Memorial Physician Practices; Lafayette, Northern (IN, KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health benefits (Medical, Dental, Vis​

Paid Time Off

Employee Assistance Program

Tuition reimbursement

And much more...

Job summary

Sycamore Springs in Layfette, IN is seeking a UR Manager to oversee utilization review activities in a psychiatric facility and to handle precertification, recertification, peer-to-peer reviews, and appeals. The UR Manager will report to the Director of Finance and supervise the UR team.

Responsibilities include ensuring certifications, coordinating with clinical services and payers, and accurately reporting denials to leadership.

Qualifications

• Education: Bachelor's degree required. Master's degree preferred.
• Experience: UR experience in psychiatric healthcare facility preferred. Leadership experience required.
• License: Current unencumbered clinical license strongly preferred.
• Additional Requirements: CPI and HWC certification required.

Responsibilities

• 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.

Skills

Leadership

Utilization Review

Clinical license

Education

Bachelor's degree

Master's degree

Job description

Sycamore Springs in Layfette, IN is seeking a UR Manager to oversee utilization review activities in a psychiatric facility and to handle precertification, recertification, peer-to-peer reviews, and appeals. The UR Manager will report to the Director of Finance and supervise the UR team.

Responsibilities include ensuring certifications, coordinating with clinical services and payers, and accurately reporting denials to leadership.