Clinical Utilization Manager

16 hours ago


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

We are seeking a highly 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 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 coordination of care.
  • Serve as a liaison to on-site external reviews, maintaining open lines of communication.
  • Maintain 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 the treatment planning process, ensuring patient-centered care.
  • Monitor documentation and discharge planning processes, providing feedback to improve quality.
  • Conduct ongoing reviews of clinical charts, identifying areas for improvement.
  • Facilitate Peer Review as outlined in the Utilization Management Plan, promoting best practices.
Requirements
  • Education: Associate's or higher in Nursing/Healthcare, or Master's or higher in Social Work or Psychology.
  • Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

The contractor will not discharge or discriminate against employees or applicants due to pay inquiries or discussions.



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