The primary responsibilities of the individual will be to supervise Utilization Review Coordinators and to review information gathered from admissions, assign cases to Utilization Review staff, monitor the progress of all UR cases, problem solve when necessary and report/mitigate all issues with Utilization.
DUTIES AND RESPONSIBILITIES (not all inclusive):
- Assigns all patients to Utilization Review Coordinators and maintains the work schedule.
- Manages any discrepancies with regard to stated benefit information and insurance verification, need for updated benefits or follow-up on a problem with a pre-certification from admissions.
- Works closely with Admissions staff/Admissions Manager to ensure patient information is accurate and pre-certification is complete.
- Supervises Utilization Review Coordinators to ensure they are following up on the information after it is verified and pre-certified appropriately.
- Assists and oversees any denials, retro-reviews and documentation thereof.
- Notifies Billing Manager of unusual or complicated account situations in writing.
Minimum 5 years’ experience as licensed Registered Nurse, Counselor or Social Worker. Minimum 5 years’ experience in medical/psychiatric Utilization, Managed Care or billing.
Minimum 1 year supervisory experience in clinical setting/utilization.