Utilization Review Supervisor- Full Time

Lake Charles Memorial Hospital; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Lake Charles Memorial Health System is seeking an experienced Utilization Review Supervisor to oversee day-to-day operations of the UR team. You will guide staff, review records for patterns, and drive efficiency, reductions in denials, and adherence to policies.

The role requires a Bachelor's degree, at least five years in utilization review or related healthcare functions, and strong communication skills to articulate findings and collaborate with the Director of Psychiatric Services.

Qualifications

• 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.

Responsibilities

• Review patients' utilization records to identify patterns and make recommendations for improvement.
• Review patient utilization data trends and patterns to identify areas of deficiency and suggest strategies to improve patient care.
• Review patients' utilization records to ensure accurate and timely billing for services provided.
• Conduct utilization reviews in accordance with policies and procedures.
• Review 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.

Skills

Communication skills

Interpersonal skills

Education

Bachelor's degree in a related field or equivalent

Job description

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 ie reduction in denials & or be more efficientSUPERVISION 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 patients 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

• Bachelors 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 patientsMust 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 its the care we provide our patients and its 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