What are the responsibilities and job description for the MGR - UTILIZATION REVIEW / MGMT position at UHS?
The Manager of Utilization Review is responsible for managing the Utilization department staff members, executing and managing the UR functions accurately and timely, included but not limited to the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals logs and reviews the progress of all appeals activity.
Qualifications
Education: Bachelor, Diploma or Associate Degree in Nursing from an accredited school as a Registered Nurse.
Experience: A minimum of five (5) years direct clinical experience in a psychiatric or mental health treatment setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
Licensure: Must maintain a valid Indiana Registered Nursing and driver's license.
Additional Requirements: CPR Certification. May be required to work overtime and flexible hours.