Manager-Utilization Management

• SIGN-ON BONUS: $5,000 if Licensed Registered Nurse (RN)

ESSENTIAL FUNCTIONS:

• 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.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Associate's degree required. Bachelor's or master's degree in social work, behavioral or mental health, Nursing or other related health field preferred.

• Four or more year's clinical experience with the population of the facility and previous experience in utilization management required.

• One or more years supervisory experience required.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• If applicable, current licensure as an LPN or RN 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.

• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).

• First aid may be required based on state or facility requirements.

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances

(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.