What are the responsibilities and job description for the DIR - UTILIZATION REVIEW / MGMT position at UHS?
Responsibilities
Qualifications
- Responsible for oversite an overall function of the utilization department
- Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
- Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
- Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
- Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
- Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
- Facilitates physician reviews with payers as required.
- Performs other duties as assigned/required by this position.
Qualifications
- Bachelor’s degree in Nursing or Master’s Degree in Psychology, counseling, Social Work or other related field is preferred
- Three (3) to five (5) years’ experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred.
Florida nursing license or Licensed Mental Health Counselor with experience in Utilization Review and/or auditing of medical billing records. Previous Psych experience is preferred.
Good oral and written communication skills required to communicate in a clear and concise manner with patients, physicians, staff and administration. Stable emotional makeup required to work in a fast paced environment with frequent interruptions.
Salary : $0
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