Utilization Review Manager (On-Site) (279)

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.