Utilization Review Supervisor - Full Time

Lake Charles Memorial Hospital • Lake Charles, LA

2d • Onsite

About The Position

The Utilization Review Supervisor oversees the day-to-day functions of the department and staff. This role actively seeks areas for department improvement, such as reducing denials or increasing efficiency. The position reports directly to the Practice Manager.

Requirements

• Registered Nurse with 2 years minimum experience in the acute behavioral health setting.
• Louisiana Nursing License or multi-state compact nursing license.
• Crisis Response Training.
• CPR certification.
• Require use of nursing skills and knowledge in order to provide care for patients in a hospital setting.
• Must be able to critically appraise care delivered to patients and make recommendations to improve the quality of care.
• Ability to articulate observations and utilization management needs in a clear and concise manner.
• Excellent communication and interpersonal skills.

Responsibilities

• Reviewing patients' utilization records to identify patterns and make recommendations for improvement.
• Reviewing patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care.
• Reviewing patient's utilization records to ensure accurate and timely billing for services provided.
• Conducting utilization reviews in accordance with policies and procedures.
• Reviewing the daily held claims report and overseeing the correction of filing claims.
• Overseeing documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
• Submitting daily Utilization Review reports in department huddles and monthly leadership meetings.
• Overseeing all utilization review and management activities in psychiatric services and reporting findings to the Director of Psychiatric Services.

Benefits

• Great Place to Work certification implies a positive work environment and employee support.
• Opportunity for professional growth.
• Organizational culture that supports employee well-being.

What This Job Offers

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