Utilization Review Supervisor- Full Time

Job Description

Job Description

DESCRIPTION OF POSITION:

• The Utilization Review Supervisor oversees day to day functions of the department and staff. The Manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.

SUPERVISION: Reports directly to the Practice Manager

RESPONSIBILITIES AND DUTIES:

• Responsible for reviewing patients' utilization records to identify patterns and to make recommendations for improvement
• Responsible for reviewing patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care.
• Responsible for reviewing patient's utilization records to ensure accurate and timely billing for services provided.
• Responsible for conducting utilization reviews in accordance with policies and procedures.
• Responsible for reviewing the daily held claims report and oversee correction of filing claims.
• Oversee documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
• Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
• Oversee all utilization review and management activities in psychiatric services and report findings to Director of Psychiatric Services.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• Bachelor’s degree in a related field or equivalent work experience required.
• Minimum of 5 years of experience in utilization review, medical claims, or related healthcare functions required.
• Demonstrated knowledge of the utilization review of departmental processes, workflows, policies, procedures, and the documentation standard required.
• Ability to articulate observations and utilization management needs in a clear and concise manner.
• Excellent communication and interpersonal skills.

Physical Demands/Work Environment

• Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time.
• Must be able to respond quickly and effectively to emergency and non-emergent situations.
• May be required to assist in controlling disorderly conduct or combative patients.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

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