Manager, Utilization Review
About The Position
Bradford Health Services provides addiction treatment programs, resources, and community through drug and alcohol rehabilitation facilities across the Southeast. The Utilization Review Manager helps ensure that services are medically necessary, efficient, and compliant with regulatory standards by evaluating patient records, treatment plans, and clinical data. The role collaborates with healthcare providers, insurance companies, and case managers to obtain timely approvals and support appropriate patient care and outcomes. The manager oversees insurance certification and the Utilization Review staff’s daily work, coordinates reviews and related documentation, and supports quality improvement, staff education, and staff development. The position has unrestricted access to patient-identifying and health information and requires compliance with applicable confidentiality and privacy regulations.
Requirements
- Current RN, LPC, or LCSW license.
- At least two years of experience in utilization review.
- Good grammatical and communication skills.
- Skill in Microsoft Office applications and working knowledge of office equipment.
- Ability to see and read handwritten or printed notes and hear and/or interpret instructions, with or without corrective devices.
- Ability to sit continuously for approximately seven hours per eight-hour shift.
- Ability to walk within the facility for approximately two hours per day.
- Emotional and physical capability to function under stressful situations.
- If recovering, two years of continuous, verifiable abstinence.
Responsibilities
- Oversee facility insurance certification, including precertification and continued stay reviews, and ensure denials, appeals, and reconsiderations are completed in a timely manner.
- Know and abide by the general provisions of 42 CFR Part 2 and 45 CFR HIPAA requirements.
- Coordinate and manage the day-to-day activities of Utilization Review staff.
- Complete daily reports, assign cases to Utilization Coordinators, and coordinate with other departments to complete the Utilization Review process.
- Maintain the facility’s UR Activity Log, recording reviews, financial classifications, and Utilization Review information and activity.
- Provide coverage or reassign activities as needed to ensure precertifications and continued stay reviews are completed promptly.
- Review and maintain correspondence pertaining to certification, appeals, denials, and reconsiderations.
- Complete Utilization Management Quality Improvement indicators and report them at the quarterly PIC meeting.
- Educate Counseling staff about patient-care documentation and Crisis staff about intake assessments.
- Participate in hiring, training, and evaluation of staff as necessary.
- Work in a constant state of alertness to perform the job safely.
- Work cooperatively with coworkers, managers, clients, and prospective managers.
- Maintain regular attendance.
- Perform other duties assigned by the supervisor.
Benefits
- Three BCBSAL medical plan options with improved rates, co-pays, and prescription benefits.
- Coverage options for domestic partners and a wider network of in-network providers.
- Employee Assistance Program with digital wellness tools, including CBT modules and wellness coaching.
- Voluntary pet, home, and auto insurance; family legal services; and other coverages.
- Student loan repayment available for nurses and therapists.
- 401(k) plan through Voya.
- Paid time off.
- Part-time employees working 20 hours or more per week can access dental, vision, life, accident insurance, and telehealth options.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
