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Director of Utilization Review/Case Mgt

2 months ago

Monroe, United States Freedom Behavioral Hospital of Monroe Full time
Job DescriptionJob DescriptionSalary:


Freedom Behavioral Hospital of Monroe has an immediate opening for a Utilization Review Director.  At Freedom, we put patient care first in all we do, and our people make that possible. We know that your best work happens when you live your best life and share your unique talents.  If fulfilling your career potential in an environment where you know you have made a difference in the lives of others sounds appealing, this is the job for you.

The Utilization Review (UR) Director:  

  • Provides appropriate care by assessing and interpreting data based on the patient's status and the age specific needs of the individual.
  • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay to comply with governmental and insurance company requirements. 
  • This position is responsible for review of precertification requests for medical necessity, referring to the medical director those that require additional expertise. 
  • The UR director will be responsible for precertification reviews, concurrent reviews, and discharge reviews-- extending the length of stay for patients as appropriate and provide appropriate consultation and referral to Case Management/Social Services personnel. 
  • Collaborate with insurance case managers, our physicians, and clinical staff to maximize patient outcomes.
  • Audit charts and make necessary recommendations to staff regarding utilization review
  • Tracking trends and data for the patients each month and present data to our Quality Team—to ensure that the hospital is providing efficient care and managing resources appropriately.
  • Facilitate peer reviews for physicians to discuss the care needed for patient as well as send in appeals on behalf of the patient to receive reimbursement for care that our physicians felt necessary.

PREFERRED KNOWLEDGE, SKILLS, AND/OR EXPERIENCE REQUIRED:
Education: A social work degree is preferred or nursing education
License: Nursing License, Social Worker License, or Healthcare Administration
Experience: 1+ years of working with health insurance companies (Medicare/Medicaid/PPO’s) AND discharge planning.
General  Requirements
Effective verbal communication skills
Effective organizational skills
Effective interpersonal skills
Analytical problem solving skills
Ability to read and comprehend written instructions; ability to follow verbal instructions
Proficient knowledge of PC computers
Basic understanding of DSM V diagnostic criteria
Basic understanding of medical and psychiatric diagnoses and conditions


****All Applicants selected for employment will be required to undergo a post-offer drug test and federal background investigation.