Manager, Utilization Review at Lifepoint Health

Job Description

Position Summary:

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.

Qualifications

Education: Bachelor's degree required. Master's degree preferred.

Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.

License: Current unencumbered clinical license strongly preferred.

Additional Requirements: CPI and CPR certification preferred. May be required to work flexible hours.

Job Responsibilities

Oversees the UR department, ensuring staff has completed all assignments and monitors performance.

Ensures all pre-certifications are completed for inpatient and outpatient services.

Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.

Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.

Works with DON to ensure documentation requirements are met.

Ensure appeals are completed thoroughly and on a timely basis.

Interface with managed care organizations, external reviews, and other payers.

Communicate with physicians to schedule peer to peer reviews.

Accurately report denials.

PHYSICAL, MENTAL, AND SPECIAL DEMANDS

• Ability to sit and stand (at least two-thirds of the shift) and walk (possibly one-third of the shift).
• Ability to reach above, or below waist height, kneel, bend, stoop, turn, and twist (occasionally to frequently).
• Visual ability to read charts, treatment plans, financial documents, computer screen and typewritten materials.
• Ability to frequently push/pull wheeled carts to 100 pounds.
• Ability to frequently lift and carry 10 lbs.; occasionally 20 to 50 lbs.
• Ability to work in an environment where chemicals are frequently used for cleaning, where medical and electrical hazards may be present and where dust, mist and steam are frequently generated in housekeeping tasks.
• Ability to work at a rapid pace and perform a variety of repetitive duties.
  
  

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.