What are the responsibilities and job description for the Utilization Review Manager position at Harbor Oaks Hospital?
Overview
Harbor Oaks Hospital is looking for a PRN - Utilization Review Manager to join our team!
Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI.
Non-Exempt Position
Monday - Friday - Day Shift (2 days per week)
Rate of Pay: $25.00 - $35.00 per hour (based on experience)
Responsibilities
PURPOSE STATEMENT:
Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
ESSENTIAL FUNCTIONS:
- Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
- Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
- Evaluate the utilization program for compliance with regulations, policies and procedures.
- Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
Qualifications
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
- First aid may be required based on state or facility requirements.
HOAK01
Salary : $25 - $35
