Utilization Review Supervisor- Full Time

Lake Charles Memorial Hospital; Lake Charles (LA); On-site; USD 70,000 - 90,000; Full time

Job summary

Lake Charles Memorial Health System is seeking an Utilization Review Supervisor to oversee day-to-day UR operations, guide staff, and pursue department improvements such as reducing denials and increasing efficiency.

You will review patient utilization data, ensure accuracy of billing, maintain compliance with policies, and report findings to leadership, including the Director of Psychiatric Services.

Qualifications

• Bachelor’s degree in a related field or equivalent work experience.
• Minimum of 5 years of experience in utilization review, medical claims, or related healthcare functions.
• Excellent communication and interpersonal skills.

Responsibilities

• Review patients' utilization records to identify patterns and recommend improvements.
• Review patient utilization data, trends, and patterns to identify deficiencies and improve patient care.
• Review patient's utilization records to ensure accurate and timely billing for services.
• Conduct utilization reviews in accordance with policies and procedures.
• Review daily held claims report and oversee correction of filing claims.
• Oversee documentation of providers and staff to ensure medical stay meets medical necessity.
• Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
• Oversee utilization review and management activities in psychiatric services and report findings.

Skills

Communication skills

Utilization review knowledge

Interpersonal skills

Education

Bachelor’s degree or equivalent

Job description

Location: Lake Charles, LA

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

• Bachelor’s degree in a related field or equivalent work experience required.
• Minimum of 5 years of experience in utilization review, medical claims, or related healthcare functions required.
• Demonstrated knowledge of the utilization review of departmental processes, workflows, policies, procedures, and the documentation standard required.
• 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.