Manager, Utilization Review

Job Description

Job Description

Position Title: Utilization Review Manager

Department: Administrative

Reports To: Executive / Program Director

Supervises: NA

Entry Level Qualifications:

Must have a current RN, LPC or LCSW license. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in Microsoft Office applications and have a working knowledge of office equipment.

1. Must be able to see and read handwritten or printed notes and hear and/or interpret instructions (with or without corrective devices.)

2. Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift.

3. Must be able to walk within the facility a total of approximately two (2) hrs. per day.

4. Must be emotionally and physically capable of functioning under stressful situations.

5. If recovering, two years of continuous verifiable abstinence.

General Responsibilities:

Oversee the coordination of the facility's insurance certification including precertification and continued stay reviews, as well as insure all insurance denials, appeals and reconsiderations are completed in a timely manner.

Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records”, and 45 CFR “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and patient health information.

Essential Functions:

1. Coordinate and manage the day to day activities of the Utilization Review Staff.

2. Complete daily reports and assign cases to the Utilization Coordinators, as well as, coordinate with other departments as needed to complete the Utilization Review process.

3. Ensure maintenance of "UR Activity Log", which records every review for the facility with financial classification and U.R. information/activity.

4. Fill in as needed, or re-assign activities, in order to make sure all pre-certifications and continued stay reviews are completed in a timely manner.

5. Review and maintain any correspondence pertaining to certification, appeals, denials or reconsiderations.

6. Complete all Quality Improvement indicators for Utilization Management and report those indicators at the quarterly PIC meeting.

7. Educate Counseling staff regarding documentation of patient care; and educate Crisis staff regarding intake assessments.

8. Participate in the hiring, training, and evaluation of staff as necessary.

9. Ability to work in a constant state of alertness as to perform the job safely.

10. Ability to work in cooperative manner with co-workers, managers, clients and

prospective managers.

11. Regular attendance.

12. Any other duties as assigned by supervisor.

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Staff Program Date

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Witness Date

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