Utilization Management Behavioral Health

Utilization Management Behavioral Health

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed.

Bachelor's degree in Nursing from an accredited school of nursing and three years' work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required.

Mobility & Posture: Standing: Continuous; Sitting: Continuous; Walking: Continuous; Climbing stairs: Infrequent; Working indoors: Continuous; Working outdoors (temperature extremes): Infrequent; Working from elevated areas: Frequent; Working in confined/cramped spaces: Frequent; Kneeling: Infrequent; Bending at the waist: Continuous; Twisting at the waist: Frequent; Squatting: Frequent

Manual Dexterity & Strength: Pinching operations: Frequent; Gross motor use (fingers/hands): Continuous; Firm grasping (fingers/hands): Continuous; Fine manipulation (fingers/hands): Continuous; Reaching overhead: Frequent; Reaching in all directions: Continuous; Repetitive motion (hands/wrists/elbows/shoulders): Continuous; Full use of both legs: Continuous; Balance & coordination (lower extremities): Frequent

Lift/carry 50 lbs. unassisted: Infrequent; Lift/lower 50 lbs. from floor to 36": Infrequent; Lift up to 25 lbs. overhead: Infrequent; Exert up to 50 lbs. of force: Frequent; Examples: Transfer 100 lb. non-ambulatory patient = 50 lbs. force; Push 400 lb. patient in wheelchair on carpet = 20 lbs. force; Push patient stretcher one-handed = 25 lbs. force

Vision & Sensory: Maintain corrected vision 20/40 (one or both eyes): Continuous; Recognize objects (near/far): Continuous; Color discrimination: Continuous; Depth perception: Continuous; Peripheral vision: Continuous; Hearing acuity (with correction): Continuous; Tactile sensory function: Continuous; Gross motor with fine motor coordination: Continuous; Olfactory (smell) function: Continuous; Respirator use qualification: Continuous

Work Environment & Conditions: Effective stress management: Continuous; Rotating shifts: Frequent; Overtime as required: Frequent; Latex-safe environment: Continuous