What are the responsibilities and job description for the Utilization Manager- PHP (Remote) position at Timberline Knolls?
Our Mission
Our mission is to offer innovative care solutions for the development of emotionally strong, personally responsible, and socially resilient girls and women. We are committed to maintaining a safe, nurturing environment where each girl or woman can benefit from superior individualized treatment provided by experienced professionals with relentless compassion and an unconditional joyful spirit.
Benefits
Timberline Knolls brings diversity and flexibility with our offers on competitive salary and an excellent benefits package. Our benefits package includes: paid time off, medical, dental, vision, disability, life insurance; and 401(k). TK also offers a supportive and diverse work environment, training in evidenced-based practices and substantial opportunities for growth.
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 through ongoing clinical reviews until patient discharges from treatment.
Evaluate the utilization operation for compliance with mandatory policies and procedures.
Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
Maintain efficient, positive customer service attitude towards patients, their families and co-workers while being responsive to customer needs.
May provide oversight and direction to utilization staff.
This role is Remote.
OTHER FUNCTIONS:
Perform other functions and tasks as assigned.
Education
Bachelor's or better in Nursing/Healthcare or Psychology.
Licenses & Certifications
Reg Nurse
CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).
First aid may be required based on state or facility.
Experience
Required- 1 year(s): One or more years of supervisory experience required
- 4 year(s): Four or more year's clinical experience with the population of the facility
- 1 year(s): previous experience in utilization management preferred.
Education
Required- Bachelors or better in Psychology or related field
- Bachelors or better in Nursing/Healthcare or related field
Licenses & Certifications
Preferred- Reg Nurse
- Lic Practical Nurse
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)