Utilization Review Manager
Location
Englewood, CO | United States
Job description
Fully On-Site Role
Utilization Review Manager
Salary/Hourly: $65-75,000/yr
Members of our team Enjoy:
Working with a highly engaged staff
- Healthy staffing levels
- Flexible scheduling
- Career growth
- Competitive compensation
- Health, Vision, Dental, 401k, and Paid Time Off
UKG Wallet – We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own schedule.
Denver Springs is a 96-bed behavioral hospital located in Englewood, CO. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Denver Springs we are dedicated to Changing People’s Lives®.
The responsibility of the UR Manager is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Manager will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals.
- Oversees the Utilization Review department, ensuring staff has completed all assignments and monitors performance.
- Acts as a liaison between managed care organizations and the facility’s behavioral health clinical treatment team.
- Conducts clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
- Monitors patient length of stay and conducts initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
- Facilitates peer to peer reviews between the facility treatment provider and the managed care physician.
- Assists the Assessment Department with completion of the precertification process for admissions.
- Provides ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.
Qualifications:
- Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment.
- Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers.
- Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team.
- Strong computer skills and ability to navigate electronic systems applicable to job functions.
Requirements:
- Bachelor’s degree or current clinical license strongly preferred
- CPR and CPI Certification within 30 days of employment
- Previous utilization review experience in a psychiatric healthcare facility preferred
- Education and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field preferred
Job tags
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