Utilization Manager, SW

Responsible for carrying at patient care review program which facilitates the appropriate use of resources and quality of care.

JOB RESPONSIBILITIES AND STANDARDS OF PERFORMANCE:

Responsibility and Standards

1.Develop collaborative relationships with MCO's including participating in third party on-site visits and appeals.

Weight: 20%

Responsibility and Standards:

2.Consult to administrative/clinical staff regarding utilization management related

issues.

Weight: 15%

Responsibility and Standards:

3.Participates in daily clinical rounds, or otherwise reviews cases with clinicians.

Weight: 15%

Responsibility and Standards:

4.Performs telephone reviews with managed care staff.

Weight: 20%

Responsibility and Standards

5.Makes appropriate IDX entries and assists Patient's Financial Services Department when indicated.

Weight: 15%

Responsibility and Standards

6.Negotiates and processes single case agreements as needed.

Weight: 5%

Responsibility and Standards

7.Participates on McLean committees and assists in CQI efforts as needed.

Weights 5%

Responsibility and Standards

8.Assists in developing and refining department policies and practices.

Weights 5%

Education/Licensure:

RN, LICSW, LMHC, Ph.D., with current Massachusetts license

Skills:

Excellent clinical skills. Interpersonal, communication and organizational skills plus ability to make judgments are essential.

Experience:

Two years clinical experience, working with psychiatric in-patient population preferred. Previous utilization management experience preferred.