Manager, Utilization Review

LifePoint Hospitals • Cedar Park, TX

41d

About The Position

The responsibility of the UR Manager is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Manager will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals.

Requirements

• Bachelor's degree required.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license strongly preferred.

Nice To Haves

• Master's degree preferred.
• CPI and CPR certification preferred.
• May be required to work flexible hours.

Responsibilities

• Oversees the UR department, ensuring staff has completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with DON to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Hospitals
• Number of Employees: 5,001-10,000 employees