- Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
- Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
- Evaluate the utilization program for compliance with regulations, policies and procedures.
- Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
- Perform other functions and tasks as assigned.
- Associate's degree required. Bachelor's or master's degree in social work, behavioral or mental health, Nursing or other related health field preferred.
- Four or more year's clinical experience with the population of the facility and previous experience in utilization management required.
- One or more years supervisory experience required.
- If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
- First aid may be required based on state or facility requirements.
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Lexington Medical Center West Columbia, United States*Physician Advisor, Utilization Management: Join Lexington Medical Center in Columbia, SC* · Join us as our *Physician Advisor (Medical Director) of Utilization Management* and help shape the future of healthcare delivery through effective resource utilization, exceptional patien ...
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Shift Manager
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Accounting Manager
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Account Manager
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Accounting Manager
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Assistant Manager/Restaurant Manager, full-time
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Manager-Utilization Management - Columbia, United States - Acadia Healthcare
Description
*SIGN-ON BONUS: $5,000 if Licensed Registered Nurse (RN)
ESSENTIAL FUNCTIONS:
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.