What are the responsibilities and job description for the Utilization Review Manager position at Clean Recovery Centers?
Job Details
Description
Reports to: RCM Director
Job Summary: The Utilization Review Manager (URM) ensures the efficient use of healthcare services by evaluating and monitoring treatments and procedures. The URM works closely with Clinical staff and insurance providers to optimize resource utilization and improve patient care.
Key Responsibilities:
• Oversee the utilization review process to ensure medical services are necessary and cost effective.
• Establishes a file on all incoming clients with insurance and maintains authorization for reimbursement from pre-certification through continuing stay reviews, and discharge of referral.
• Collaborate with physicians and healthcare teams to review and approve treatment plans.
• Maintains internal tracking of documents and spreadsheets daily and/or as instructed.
• Analyze Utilization data to identify trends and opportunities for improvement.
• Train and support staff on utilization review procedures and guidelines.
• Maintain positive relationships with insurance providers and manage authorization processes.
• Prepare reports on utilization trends, KPI’s and resource allocation.
• Ensure compliance with healthcare regulations and confidentiality laws.
• All other duties or task assigned by the management or executive staff
Qualifications
Education: Degree in nursing, healthcare management, or a related field.
• Experience: Familiarity with ASAM, Milima, and LOCUS criteria; experience in healthcare utilization management.
• Skills: Strong communication, organizational, and analytical skills; ability to work under stress and adapt to changes while leading a team.
• Certifications: Certification in utilization management preferred; licensure in nursing or social services is a plus.
Salary : $65,000 - $75,000
