Clinical Utilization Manager

3 days ago


Shreveport, Louisiana, United States Specialists Hospital Shreveport Full time
Job Summary

We are seeking a highly skilled Clinical Utilization Manager to join our team at Specialists Hospital Shreveport. As a key member of our healthcare team, you will be responsible for coordinating care plans, conducting pre-certification and concurrent reviews, and ensuring efficient utilization of health services.

Key Responsibilities
  • Perform risk-identification, preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations.
  • Ensure care delivered in a fiscally responsible manner, meeting designated quality metrics.
  • Report exceptions and variances to the Quality Committee and/or responsible staff.
  • Makes informed recommendations as to Level of Care, Length of Stay, and documentation for medical necessity is appropriate.
  • Ensures payer requirements met to insure payment for services rendered.
Requirements
  • Associate or Bachelor's Degree in Nursing.
  • Current state RN licensure.
  • 5 years Utilization Review experience preferred.
  • Experience in a fast-paced environment; orthopedic and spine experience strongly recommended.
Benefits
  • Seven paid holidays.
  • Sick and vacation after waiting period.
  • Health, vision, and dental coverage.
  • Employer-paid life insurance and long-term disability.
  • 401k with employer contribution.


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