Utilization Review Manager - Mental Health Inpatient

Harboroaks; New Baltimore (MI); On-site; USD 34,000 - 48,000; Part time

Job summary

Harbor Oaks Hospital in New Baltimore, MI seeks a Utilization Review Manager to monitor utilization of services and optimize reimbursement while maximizing patient benefits. This non-exempt, PRN role operates weekdays with a day shift.

Qualifications include current licensure as a nurse or social work professional as required by state, CPR and de-escalation certifications. Strong leadership and coordination with payers are essential.

Qualifications

• 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.

Responsibilities

• 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.

Job description

Harbor Oaks Hospital in New Baltimore, MI seeks a Utilization Review Manager to monitor utilization of services and optimize reimbursement while maximizing patient benefits. This non-exempt, PRN role operates weekdays with a day shift.

Qualifications include current licensure as a nurse or social work professional as required by state, CPR and de-escalation certifications. Strong leadership and coordination with payers are essential.