Utilization Review Manager

About Us

Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast.

How You'll Contribute

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 Director of Finance the authorization status of current patients and appeals.

Essential Functions

• 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 Director of Finance or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with clinical services team 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.

Qualifications And Requirements

• Education: Bachelor's degree required. Master's degree preferred.
• Experience: Previous utilization review experience in a psychiatric healthcare facility preferred. Leadership experience required.
• License: Current unencumbered clinical license strongly preferred.
• Additional Requirements: CPI and HWC certification required.