Utilization Review Supervisor - Full Time

Description Of Position

The Utilization Review Supervisor oversees day-to-day functions of the department and staff. The Manager actively seeks areas for the department to improve (i.e., reduction in denials) and/or be more efficient.

SUPERVISION

Reports directly to the Practice Manager

Responsibilities And Duties

• Reviews patients' utilization records to identify patterns and make recommendations for improvement
• Reviews patient utilization data, trends, and patterns to identify areas of deficiency and suggest strategies to improve patient care
• Reviews patient's utilization records to ensure accurate and timely billing for services provided
• Conducts utilization reviews in accordance with policies and procedures
• Conducts daily claims review and oversees claim corrections
• Submits daily Utilization Review reports in department huddles and monthly leadership meetings
• Oversees utilization review and management activities in psychiatric services and reports findings to the Director of Psychiatric Services

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
• Requires use of nursing skills and knowledge in providing care for patients in a hospital setting
• Utilization review nurses must be able to critically appraise care delivered to patients and make recommendations to improve the quality of care
• Excellent communication and interpersonal skills

Physical Demands/Work Environment

• 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

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s 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.