Utilization Manager

Arkansas Children's Hospital • Little Rock, AR

1d

About The Position

The Utilization Manager improves overall quality of clinical documentation to ensure that information in the medical record accurately reflects client's care and progress, and thus utilization of resources. This role works with providers to correctly capture that services being delivered are medically necessary and timely.

Requirements

• RN or LPC Required
• Masters Degree Required
• 3 years in Mental Health/ Hospital Setting Required
• Master's degree in a related field of study.
• 1 of the following certifications is required - Licensed Certified Social Worker (LCSW) - Arkansas Professional Board, Licensed Professional Counselor (LPC) - Arkansas Board of Examiners in Counseling, RN License (AR or Compact State) - Arkansas State Board of Nursing (ASBN)

Nice To Haves

• Master's degree in a related field of study.
• Licensed Certified Social Worker (LCSW) - Arkansas Professional Board
• Licensed Professional Counselor (LPC) - Arkansas Board of Examiners in Counseling
• RN License (AR or Compact State) - Arkansas State Board of Nursing (ASBN)

Responsibilities

• Complete concurrent and retrospective medical record reviews to ensure services are appropriate, efficient, and compliant with payer and regulatory guidelines.
• Process pre-authorizations and requests for services that are medically necessary and adherent to payer rules.
• Consult with multidisciplinary team members regarding patient diagnosis, medical justification, length of treatment, and case documentation.
• Represents the clinical and administrative team with payers for any appeals or disagreements related to care plans.
• Provide training and education about utilization requirements to clinical and supervisory staff.
• Demonstrate competency on mental health symptomology, treatment options and efficacies, and impact of trauma and mental health on overall well-being.
• Participate in quality or accreditation audits to ensure program compliance on utilization review regulations.
• Completes clinical supervision and staffing to clinicians completing their required supervision hours for full licensure, if necessary.
• Knowledge of regulatory requirements and Arkansas laws governing services to children, adolescent and adults preferred.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level