Utilization Review Manager (Fully Remote) Job at Assurance Health System
Utilization Review Manager (Fully Remote)
Full-Time
Assurance Health System
For this unique position, we are seeking a highly skilled, tech-savvy, and dedicated individual with hospital and/or behavioral health utilization review experience who is capable of maintaining a fully remote work environment while ensuring seamless collaboration with the rest of the hospital's treatment team. The ideal candidate will be a reliable self-starter with a successful background in utilization review
or authorization coordination for acute care or behavioral health facilities.
Principal Functions:
Implement, coordinate, and participate in a variety of admissions, utilization management, and ongoing review of clinical documentation in acute behavioral health setting. Determine if a patient’s insurance is appropriate and acceptable for admission to the hospital. Collaborates daily with clinical treatment team to determine continued stay criteria. Collaborates with social services for discharge planning in accordance with outcomes of clinical reviews. Communicates efficiently with nursing staff and other members of the clinical team to ensure proper documentation in accordance with CMS standards and regulations. Collaborates with administrative staff at the hospital to ensure clinical documentation needed for UR functions is received in a timely manner. Manages and coordinates organization-wide efforts to ensure that performance management and quality improvement programs are in line with the goals of the department. Candidate will be required to complete insurance verification for entire hospital system (rotating on call basis)
Minimum Qualifications:
Education: Work generally requires a Bachelor's or Master's degree in Social Work, Behavioral Science or a related field. Active LPN or RN may be considered in lieu of Bachelor’s degree, depending upon experience.
Training:
Work requires a minimum of two years of experience in patient/health care relations or a human services field (e.g. case management).
Skills: Utilization or case management in a behavioral health system either through managed care or healthcare provider is highly desirable.
Experience in utilization management or procurement of authorizations with either a psychiatric hospital, behavioral treatment facility, or as a case manager for an insurance company with experience in behavioral health.
This individual MUST have an expert level of understanding and proficency with computer and apple IOS technology including a high level of familiarity with Microsoft office suite, Medicare/Medicaid/Private insurance web platforms and portals, and Apple IOS.
Previous experience with insurance benefit verification and familiarity with Managed Care entities, Medicaid, and Medicare is required.
Experience working with geriatric psychiatric population is highly desirable.
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