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Utilization Manager

1 month ago

Peoria, Illinois, United States Carle Health Full time
Job Summary

We are seeking a highly skilled Utilization Manager to join our team at Carle Health. The successful candidate will be responsible for providing utilization management services to our inpatient unit, ensuring the delivery of appropriate, cost-effective, and clinically effective services across the continuum of care.

Key Responsibilities
  • Collaborate with the interdisciplinary team to facilitate placement of patients in the most appropriate level of care and ensure insurance requirements are met.
  • Review all admissions to determine the appropriateness of the admission and discuss concerns with the psychiatrist.
  • Apply admission, continued stay/transfer, and discharge criteria to each patient and review their records regularly.
  • Work with the Patient Financial Services Department to ensure patients meet financial eligibility for treatment services.
  • Participate in interdisciplinary treatment conferences to review patient progress and plan for discharge.
  • Maintain a working knowledge of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V) and current Mental Health and Developmental Disabilities Code.
  • Assist in quality improvement processes, including data collection, analysis, and report generation.
Requirements
  • Bachelor's Degree in Psychology, Social Work, or a related field.
  • Minimum of 3 years of experience in behavioral health.
  • Basic computer knowledge and ability to utilize PC software.
  • Excellent communication and critical thinking skills.
What We Offer

Carle Health is an Equal Opportunity Employer and offers a competitive salary and benefits package. We are committed to providing a work environment that is inclusive and respectful of all employees.