Utilization Review Manager

ERC Pathlight•Aspen, CO

2d•$93,000 - $117,000•Hybrid

About The Position

As a Manager, Utilization Review, you will hire, evaluate, and supervise Utilization Review Specialists and oversee Utilization Review operations. This role coordinates with Clinical Managers and Directors, Physicians, Business Office, and Managed Care Organizations to assure the smooth operation of Utilization Review functions and the provision of optimal patient care.

Requirements

Graduate Degree - Master's degree in psychology, counseling or social work. Alternatively, a bachelor's in Nursing
RN, IF nurse (Required)
Full clinical licensure, if mental health. (Required)
4 to 6 years Utilization review experience (Required)
2 years post-degree mental health experience in direct patient care (Required)

Nice To Haves

2 years management experience (Preferred)

Responsibilities

Clinically supervises teammates in 1:1 and group settings; provides in-moment assistance on escalated issues.
Provides oversight to assigned team by supervising, guiding, and directing employees to be effective team members.
Ensures that everyone is equipped with the right skills, tools, and talents necessary for executing their duties.
Using the established people processes (performance, development, succession, and career) to ensure that the team’s level of performance and capabilities meet current and future standards.
Advocates for optimal patient care in clinical care determination reviews by proactively reviewing and synthesizing the medical record for discussion with licensed mental health counselors and social workers and RNs at managed care organizations.
Liaison with regional management teams to discuss clinical issues and facilitate solutions to situations that involve the UR process.
Oversees regional caseload allocation.
Attends treatment team meetings to share information and represent UR department; shares clinical documentation quality concerns.