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 Director of Psychiatric Services

Education And Work Experience

• Bachelor’s degree in a related field or equivalent work experience required
• Minimum of 5 years of experience in utilization review, medical claims, or related healthcare functions required
• Demonstrated knowledge of utilization review departmental processes, workflows, policies, procedures, and documentation standards required
• Ability to articulate observations and utilization management needs in a clear and concise manner
• Excellent communication and interpersonal skills

Physical Demands/Work Environment

• Moves about within and outside of all hospital properties for long periods of time
• Responds quickly and effectively to emergency and non-emergency situations
• Absorbs accurate information with patient, family, peers, and medical personnel
• May assist in controlling disorderly conduct or combative patients

“Experience Memorial”

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.