Utilization Review Manager

Job Purpose:

The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible for overseeing the utilization review process to ensure that patient care services are delivered efficiently and effectively. This role involves collaborating with healthcare providers to optimize patient outcomes and resource utilization while ensuring compliance with regulatory and accreditation standards.

Key Responsibilities:

• Lead and manage the utilization review team to ensure timely and accurate assessments of patient care plans. • Develop and implement utilization review policies and procedures in accordance with organizational and regulatory requirements. • Collaborate with clinical staff to review patient cases and determine the appropriateness of care and services provided. • Analyze data and prepare reports on utilization trends, recommending improvements to enhance patient care and resource management. • Serve as a liaison between the healthcare team and insurance providers to facilitate authorizations and resolve any coverage issues. • Provide education and training to staff on utilization review processes and best practices. • Ensure compliance with all relevant regulations, standards, and guidelines related to utilization management. • Participate in quality improvement initiatives to enhance the efficiency and effectiveness of patient care delivery.

Required Education:

• Current Registered Nurse (RN) license in the state of Florida or Florida Licensure as a clinical social worker, mental health counselor, or marriage and family therapist.

Required Experience:

• Minimum of 2 years of clinical nursing experience, preferably in a behavioral health or psychiatric setting.
• At least 2 years of experience in utilization review or case management.
• Proven track record of managing and supervising healthcare teams effectively.

Required Skills and Abilities:

• Strong understanding of utilization review processes and healthcare regulations.
• Excellent analytical skills to assess patient care needs and determine appropriate levels of service.
• Proficient in electronic medical records (EMR) systems and healthcare management software.
• Exceptional communication and interpersonal skills to collaborate with healthcare providers, patients, and insurance companies.
• Ability to lead and motivate a team, ensuring compliance with organizational policies and procedures.
• Detail-oriented with strong organizational skills to manage multiple cases simultaneously.
• Ability to handle sensitive information with confidentiality and professionalism.

LifeStream Benefits

Health/Dental/Vision Insurance Short Term Disability Pension Plan 403(b) PTO (Over 4 weeks your 1st year!) Flexible Work Schedules Tuition Reimbursement Program Free Telehealth Services And More!

Important Notice

As part of our hiring process and in compliance with Section 435.04, Florida Statutes, certain positions require a Level 2 background screening. Employment offers are contingent upon meeting applicable requirements. For more details on Level 2 background screening requirements, please visit: Florida Care Provider Background Screening Clearinghouse

LifeStream is an equal opportunity employer and does not discriminate against any applicant based on age, citizenship, color, covered veteran status, disability, gender identity, genetic information, marital status, race, religion, sex, sexual orientation, or other protected status in accordance with applicable federal, state, and local laws.