What are the responsibilities and job description for the Utilization Management/ Admissions Manager position at NHC and Affiliates?
Manager Utilization Management and Admissions Dept
GENERAL DESCRIPTION: Direct and manage the day-to-day operations of the Utilization Review and admissions department.
MINIMUM EDUCATION/EXPERIENCE/SKILLS:
- Bachelor's Degree in clinical field or nursing, required. Master's Degree in clinical field preferred. 2 or more year's clinical experience with the population of the facility, previous experience in utilization management preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Current licensure current clinical professional license or certification, as required, within the state where the facility provides,
- LPN or RN within the state where the facility provides services;
ESSENTIAL FUNCTIONS: Are determined by the facility and may Include, but are not limited to the following:
- Monitor utilization of continuum services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.
- Responsible for the concurrent and retrospective review for all patients,
- Act as a liaison between Medicaid reviewers/gatekeepers and the staff completing required paperwork to facilitate the Utilization Review and admissions process,
- Work with physicians, therapist and nursing staff to provide optimal review based on patient
- Work with ancillary services in order to prevent delays in
- May review charts, make necessary recommendations to the physicians, In regard to utilization review and specific managed care issues.
- Assist Director with managing the Um and admission dept. staff
- Provide oversight and direction to utilization
- Demonstrates customer service behaviors when interacting with patients, team members and guests.
- Communicates patient information in a concise, accurate, timely, and
-
confidential manner.
- Utilizes available resources to assist with communication needs
- Ensures that accurate Information is communicated in a timely and effective manner throughout the hospital.
- Maintains a collaborative relationship with other
Professional Image and Behavior:
- Adheres to the department hospital code
- Focuses on the needs of the patients and
- Avoids discussion of personal issues and/or complaints in the presence of the
- Assumes responsibility for behaviors and actions; accepts constructive criticism
in a positive manner.
- Participates in opportunities to promote professional
OTHER FUNCTIONS:
- Performs other functions and tasks as assigned/needed.
..
Communication:
- Uses language that is .. easily understood and appropriate for the specific
