DIR - UTILIZATION REVIEW / MGMT Job at Shift Day, West Allis, WI

blVjUTZYbHRjdUtDbzFxQnhSRE45V3N3VUE9PQ==
  • Shift Day
  • West Allis, WI

Job Description

Responsibilities

Granite Hills Hospital

Our new, state of the art, 120-bed inpatient facility features evidence-based treatment modalities and a multi-disciplinary team led by medical professionals.

Manager of Utilization Management

The Manager of Utilization Management/Review is responsible for overseeing the Utilization Management Program for Inpatient and Outpatient services. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payors.

  • Direct the response to request for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.
  • Review the effectiveness of the comprehensive interface with external reviewers, communicates with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of reviews and provide consultation as needed.
  • Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
  • Assure patients are receiving effective and appropriate treatment, based on the level of care.
  • Establish standards for customer relations and monitor the interactions between internal staff and customers to evaluate the effectiveness of customer service.
Qualifications

Qualifications: Bachelor’s degree in nursing, social work, psychology, or related field required; master’s degree preferred.  RN, LCSW, LPC or applicable license preferred. A minimum of two (2) years direct clinical experience in a psychiatric or mental health treatment setting, including one year of managing a related function preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities preferred.

Job Tags

Similar Jobs

CyberCoders

Content & Paid Ads Specialist - Digital Marketing, SEO, PPC Job at CyberCoders

 ...platforms. The ideal candidate is someone who has experience with PPC/Paid Ad Management, email marketing/demand generation, and/or...  ...who could come into our office from time to time, otherwise REMOTE is fine. What You Will Be Doing - PPC client campaign setup,... 

MyKelly

Dispositions Support Specialist Job at MyKelly

Kelly Services is actively seeking a Dispositions Support Specialist for a long term (5+ years) engagement with one of our top clients located in Muskegon, MI. Term: 5+ years Hybrid work schedule: 3 days onsite; 2 days remote Pay rate: $17/hour + benefits + PTO... 

University of Kentucky

Assistant or Associate Professor in Earth & Environmental Sciences | University of Kentucky Job at University of Kentucky

 ...Department Name: 8E060:Earth and Environmental Sciences Job Summary: The Department of Earth & Environmental Science ( EES ) in the College of Arts and Sciences at the University of Kentucky in Lexington, KY seeks to fill a tenure-eligible faculty position at... 

Get It Recruit - Healthcare

PBM Prior Authorization Pharmacist - Remote | WFH Job at Get It Recruit - Healthcare

Overview: Join our team as a Remote Prior Authorization Pharmacist, where you'll play a crucial role in ensuring efficient and accurate clinical assessments. In this position, you'll: Collaborate with various internal teams to address clinical inquiries, gather necessary... 

MVP Recruitment, LLC

Practice Manager Job at MVP Recruitment, LLC

 ...Position: Practice Manager Location: Townsend Veterinarian Hospital, Townsend, MA 01469 Website: Job Type: Full-time Overview: Townsend Veterinarian Hospital is seeking an experienced and dedicated Practice Manager to oversee the daily operations...