Utilization Review Supervisor - Full Time

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

The Utilization Review Supervisor oversees day to day functions of the department and staff. The Manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.

Description Of Position

The Utilization Review Supervisor oversees day to day functions of the department and staff. The Manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.

SUPERVISION:

Reports directly to the Practice Manager

Responsibilities And Duties

• Responsible for reviewing patients' utilization records to identify patterns and to make recommendations for improvement
• Responsible for reviewing patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care.
• Responsible for reviewing patient's utilization records to ensure accurate and timely billing for services provided.
• Responsible for conducting utilization reviews in accordance with policies and procedures.
• Responsible for reviewing the daily held claims report and oversee correction of filing claims.
• Oversee documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
• Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
• Oversee all utilization review and management activities in psychiatric services and report findings to Director of Psychiatric Services.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Education And Work Experience

• Registered Nurse with 2 years’ minimum experience in the acute behavioral health setting.
• Louisiana Nursing License or multi-state compact nursing license, Crisis Response Training, CPR
• Require use of nursing skills and knowledge in order to provide care for patients in a hospital setting. In addition, utilization review nurses must be able to critically appraise care delivered to patients and make recommendations to improve the quality of care.
• Ability to articulate observations and utilization management needs in a clear and concise manner.
• Excellent communication and interpersonal skills.

Physical Demands/Work Environment

• Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time.
• Must be able to respond quickly and effectively to emergency and non-emergent situations.
• May be required to assist in controlling disorderly conduct or combative patients.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well‑being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

Working at Lake Charles Memorial Health System | Great Place To Work®