DESCRIPTION OF POSITION:
- The Utilization Review Supervisor oversees day to day functions of the department and staff. The Manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient.
SUPERVISION: Reports directly to the Practice Manager
RESPONSIBILITIES AND DUTIES:
- Responsible for reviewing patients' utilization records to identify patterns and to make recommendations for improvement
- Responsible for reviewing patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care.
- Responsible for reviewing patient's utilization records to ensure accurate and timely billing for services provided.
- Responsible for conducting utilization reviews in accordance with policies and procedures.
- Responsible for reviewing the daily held claims report and oversee correction of filing claims.
- Oversee documentation of providers and other employees to ensure medical stay meets medical necessity and continued stay criteria.
- Submit daily Utilization Review reports in department huddles and monthly leadership meetings.
- Oversee all utilization review and management activities in psychiatric services and report findings to Director of Psychiatric Services.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
EDUCATION AND WORK EXPERIENCE
- Registered Nurse with 2 years minimum experience in the acute behavioral health setting.
- Louisiana Nursing License or multi-state compact nursing license, Crisis Response Training, CPR
- Require use of nursing skills and knowledge in order to provide care for patients in a hospital setting. In addition, utilization review nurses must be able to critically appraise care delivered to patients and make recommendations to improve the quality of care.
- Ability to articulate observations and utilization management needs in a clear and concise manner.
- Excellent communication and interpersonal skills.
Physical Demands/Work Environment
- Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time.
- Must be able to respond quickly and effectively to emergency and non-emergent situations.
- May be required to assist in controlling disorderly conduct or combative patients.
- Must be able to exchange accurate information with patient, family, peers and medical personnel.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience Memorial is more than a slogan, its the care we provide our patients and its the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.
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