Lead Case Manager

Utilization Review Supervisor

Works under the supervision of the Director of Care Management. Supervises case managers on a day to day basis. Oversees performance of case managers to ensure that participants receive quality and timely services and that program objectives are met. Resolve conflicts that arise with participants and failure to comply issues. Reviews the medical record on a concurrent basis, utilizing criteria accepted and approved by the Medical Staff, for admissions and continued stay of patients requiring acute care or observation. Monitors the plan of care to ensure the efficient utilization of resources. Collaborates with the multidisciplinary team to improve clinical care, customer satisfaction, organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management. Refers potential candidates for early discharge planning to Social Work, Hospice, Home Health or Rehab as appropriate to help facilitate transitions in care. Responsible for reviewing every hospital patient account for correct status and billing compliance. Assists with Performance Improvement monitoring and reporting activities. Performs other duties as assigned.