The Utilization Review Supervisor oversees day to day functions of the department and staff. The Manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.
SUPERVISION: Reports directly to the Practice Manager
RESPONSIBILITIES AND DUTIES:
Responsible for reviewing patients' utilization records to identify patterns and to make recommendations for improvement
Responsible for reviewing patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care.
Responsible for reviewing patient's utilization records to ensure accurate and timely billing for services provided.
Responsible for conducting utilization reviews in accordance with policies and procedures.
Responsible for reviewing the daily held claims report and oversee correction of filing claims.
Oversee documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
Oversee all utilization review and management activities in psychiatric services and report findings to Director of Psychiatric Services.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
EDUCATION AND WORK EXPERIENCE
Registered Nurse with 2 years’ minimum experience in the acute behavioral health setting.
Require use of nursing skills and knowledge in order to provide care for patients in a hospital setting. In addition, utilization review nurses must be able to critically appraise care delivered to patients and make recommendations to improve the quality of care.
Ability to articulate observations and utilization management needs in a clear and concise manner.
Excellent communication and interpersonal skills.
Physical Demands/Work Environment
Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time.
Must be able to respond quickly and effectively to emergency and non-emergent situations.
May be required to assist in controlling disorderly conduct or combative patients.
Must be able to exchange accurate information with patient, family, peers and medical personnel.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.