Supervisor, Utilization Management

UHS•Orlando, FL

8d•Onsite

About The Position

Under the direction of the Director, Utilization Management, the UM Supervisor provides oversight for the staff and work performed in the UR Department. This role ensures protocols for clinicians to review patient medical records on specific days to meet continued authorization, ensures staff knowledge of medical necessity, regulatory requirements, and standards (e.g., Joint Commission, Title 9, CMS/Medicare guidelines, EMTALA, HIPAA), and oversees processes and procedures for all UR activities, including written appeal letters for denials.

Requirements

Master’s degree required from an accredited college or university in social work, mental health related field or equivalent for licensure.
A minimum of two (2) years' experience with communication with external review organizations in chart analysis and UR field required.
Ability to work independently and set priorities.
Valid FL license: RN, LSCW, LMHC, LMFT preferred.

Responsibilities

Ensure protocol for clinicians to review the patient’s medical record on specific days to meet continued authorization.
Ensure knowledge of staff regarding medical necessity, regulatory requirements and standards, i.e. Joint Commission, Title 9, CMS/Medicare guidelines, EMTALA, HIPAA, etc.
Oversee processes and procedures for all UR activities, including written appeal letters for denials