Utilization Review Supervisor — Improve Care & Efficiency

Lake Charles Memorial Health System; Lake Charles (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

Lake Charles Memorial Health System seeks a Utilization Review Supervisor to oversee day-to-day UR department operations and staff, driving efficiency and reductions in denials.

Responsibilities include reviewing utilization records, identifying patterns, ensuring accurate billing, and reporting findings to leadership. Requires a Bachelor's degree and 5+ years in UR or related healthcare functions, with strong communication skills.

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.
• Demonstrated knowledge of UR processes, workflows, policies, 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 improvement opportunities.
• Review utilization data, trends, and patterns to detect deficiencies and recommend strategies.
• Ensure accurate and timely billing for services through utilization reviews.
• Conduct utilization reviews in accordance with policies and procedures.
• Monitor daily held claims reports 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

Interpersonal skills

Analytical thinking

Education

Bachelor’s degree or equivalent experience

Job description

Lake Charles Memorial Health System seeks a Utilization Review Supervisor to oversee day-to-day UR department operations and staff, driving efficiency and reductions in denials.

Responsibilities include reviewing utilization records, identifying patterns, ensuring accurate billing, and reporting findings to leadership. Requires a Bachelor's degree and 5+ years in UR or related healthcare functions, with strong communication skills.