Manager Utilization Review

KVC Health Systems•Webster Groves, MO

20h•Onsite

About The Position

The Utilization Review department carries with it the responsibility of managing those aspects of a patient stay that relates to the initial, concurrent and discharge interface with health plans. The Utilization Review Manager provides engaging and inclusive leadership to the UR department, who will be in frequent contact with health plans, providing clinical information developed by the treatment team and staff working with a diverse group of patients and families. This role requires high attention to detail at the very fast pace of short-term hospitalization. The role is part of the treatment team and will partner with the Admissions department, physicians, nurses, and therapists to ensure timely, accurate and complete assessments are performed on KVC’s patients and make appropriate referral for placement and services based on the assessments.

Requirements

Bachelor’s degree in human service field (i.e. social work, education, sociology, psychology, counseling, human relations) or criminal justice.
Valid driver’s license and auto insurance.
A minimum of two years of experience in Utilization Review, and at least one year of experience in a leadership role.
Intermediate skill level with Microsoft Office, including Word, Excel, and Outlook email.

Nice To Haves

Bachelor’s degree in social work and licensure with the Missouri Division of Professional Registration (MOPRO) preferred.
Experience working with economically disadvantaged, vulnerable or at-risk youth and/or young adults preferred.

Responsibilities

Practice conduct that displays respect for all KVC colleagues and community stakeholders regardless of age, gender identity, sexual orientation, race, religion, ethnicity, or veteran status
Supervises the Utilization Review Specialist to ensure completion of tasks, job description and compliance with KVC’s policies and procedures
Completes all necessary reports on utilization review data
Maintains strictest confidentiality about child/youth/family information
Frequent telephonic interface with health plans
Maintain accurate recording of information and ensure that this is provided to others in an accurate fashion
Gathers data, compiles information, and completely and accurately (including grammar and spelling) enters information into the data management system
Understands and remains up to date on JIAC and KVC policies and procedures, KVC programs and services, and outside community agencies
Communicates effectively and respectfully both orally and in writing with children/youth, family members, staff, other service agencies, and the public; uses strong active listening skills
Possesses strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
Responsible for achieving and maintaining proficiency in the utilization of KVC information systems, including but not limited to Avatar, Citrix, and UltiPro
Accountable to know and enforce the staff handbook as well as KVC Hospitals, Inc. policies and procedures
Manages Utilization Review employees, including oversight or responsibilities, approval of hours worked and PTO, compliance with KVC and accrediting body policies and procedures, fairly executing progressive disciplinary action and performance evaluations
Regularly attends treatment team and staff meeting, or reviews minutes of meetings to remain up to date
Discuss and/or obtain advance approval from Supervisor to attend training, submit check requests, vacation requests and reimbursement requests
Attend staff conferences and in-service training as required or needed