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Clinical Utilization Manager

1 month ago

Norcross, Georgia, United States Acadia Healthcare Full time
Job Summary

We are seeking a skilled Clinical Utilization Manager to join our team at Acadia Healthcare. As a key member of our Utilization Review Department, you will play a critical role in ensuring the efficient and effective management of patient care.

Key Responsibilities
  • Conduct thorough admission and concurrent reviews for assigned program patients, obtaining necessary information and verifying insurance benefits.
  • Review charts and conduct pre-certification reviews with third-party payors, meeting specified time limits.
  • Communicate review results to physicians and treatment team members, ensuring seamless collaboration.
  • Serve as a liaison for on-site external reviews, maintaining open lines of communication.
  • Manage relevant reports and data for the UR Department, ensuring accurate and timely information.
  • Complete all paperwork related to pre-certification and concurrent reviews, adhering to UR policies.
  • Daily communication with physicians, treatment team, and Business Office regarding certification and denials.
  • Coordinate and participate in treatment planning, ensuring comprehensive and effective care.
  • Monitor documentation and discharge planning processes, providing feedback on documentation procedures.
  • Conduct ongoing reviews of clinical charts, identifying areas for improvement.
  • Facilitate Peer Review as outlined in the Utilization Management Plan, promoting a culture of excellence.
Requirements
  • Associate's degree or higher in Nursing or Healthcare.
  • Masters degree or higher in Social Work or Psychology.

We are an Equal Opportunity Employer and welcome applications from qualified candidates. Please note that we cannot disclose the pay of other employees or applicants, except in accordance with applicable laws and regulations.