UTILIZATION MANAGEMENT MANAGER

UHS•Franklin, TN

61d

About The Position

At Rolling Hills, our mission is to offer compassionate, safe, effective behavioral healthcare treatment. We use solution-focused strategies and diligently strive for a safe and positive environment for patients, families, and employees. We never forget that we provide care and comfort to people in need. www.rollinghillshospital.org Rolling Hills Hospital is seeking a dedicated and detail-oriented Utilization Management Manager to join our dynamic UM team. In this role, you will be responsible for ensuring the appropriate utilization of services for patients in both our inpatient and outpatient programs. Your key responsibilities will include: Coordinating and Monitoring: Oversee the utilization of services throughout the treatment process, ensuring that patients receive the appropriate level of care. Authorization Management: Coordinate with third-party payers to secure necessary authorizations for patient services. Case Review: Evaluate the appropriateness of admissions, continued stays, and discharge plans to ensure optimal patient care. Quality Assurance: Promote and maintain high-quality patient care by analyzing, reviewing, and evaluating clinical practices within the hospital. Communication: Maintain effective communication systems through thorough documentation and verbal exchanges regarding patient treatment. Collaboration: Work with internal and external entities to ensure a seamless continuum of services and optimize reimbursement for the hospital.

Requirements

Proven experience in utilization management or a related field.
Strong analytical and problem-solving skills.
Excellent communication and interpersonal abilities.
Ability to work collaboratively in a team environment.
Knowledge of third-party payer systems and authorization processes.
Master’s Degree in Behavioral Health Field (e.g. Counseling, Social Work, Psychology) required
RN or LPN license in the state of TN considered
Current Tennessee Driver’s License
Current CPR Certification
Current HWC Certification
Experience in psychiatric setting as counselor or nurse preferred; reading, writing, and mathematical skills at the master’s degree level; skills in application of DSM methodology; excellent telephone etiquette and tact; audible speech, with good enunciation; ability to interact effectively with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes; effective oral and written communication skills; skills in analyzing and evaluating information; ability to concentrate on tasks and meet deadlines; basic data entry skills preferred; organizational, time management, problem solving, crisis management skills necessary; flexibility, creativity, and the ability to manage stress are necessary.

Responsibilities

Oversee the utilization of services throughout the treatment process, ensuring that patients receive the appropriate level of care.
Coordinate with third-party payers to secure necessary authorizations for patient services.
Evaluate the appropriateness of admissions, continued stays, and discharge plans to ensure optimal patient care.
Promote and maintain high-quality patient care by analyzing, reviewing, and evaluating clinical practices within the hospital.
Maintain effective communication systems through thorough documentation and verbal exchanges regarding patient treatment.
Work with internal and external entities to ensure a seamless continuum of services and optimize reimbursement for the hospital.