Utilization Review Manager
The Utilization Review Manager will assist the Vice President of Quality Assurance in the development, coordination, implementation, training, and evaluation of utilization review activities. This position is responsible for professional level management activities including compliance with internal, state and federal regulations and the provision of high quality, cost-effective client care.
Essential Duties and Responsibilities:
- Authorize continued billable days for all levels of care for clients admitted to the organization.
- Meet or exceed monthly billable days targets
- Provide an ongoing, systematic process for the measurements and assessment of the necessity, appropriateness, and efficiency of the use of the facility’s service and procedures.
- Compile statistics regarding authorizations and peer request and approvals for monthly reports.
- Compile statistics of insurance provider behavior and trends
- Communicate with insurance providers, clients, and providers regarding benefits and claim status.
- Facilitate physician peer reviews with managed care companies and other external agencies when warranted.
- Direct and supervise Utilization Review staff.
- Serve as a resource to staff regarding federal, state, and local regulations.
- At the request of the VP of Quality Assurance, provide support to other staff within the QA department
- Comply with applicable legal requirements, standards, policies and procedures including but not limited to those within the Compliance Plan, Code of Ethics, and HIPPA Privacy Practices.
- This job description is not intended to be all-inclusive and employees will also perform reasonably related duties as assigned by the Director of Quality Assurance.
- Master’s Degree in behavioral health or RN Degree from an accredited college or university
- At least 3 years experience in substance use disorder insurance billing and mental health insurance billing
- Knowledge in federal, state (i.e. DHCS), and private insurance standards.
- At least one year experience in performing URs
- Strong professional references attesting to high degree of customer service, punctuality, and professionalism.
- Minimum of 3 years supervisory/management experience.
- Valid California Driver’s license
Please send a resume to firstname.lastname@example.org