Utilization Review Manager

The Utilization Review Manager makes a difference!
The Utilization Review Manager coordinates thedesign, development, implementation and monitoring of the hospital'sUtilization Review functions including managing daily operations and supervisingthe staff performing utilization management activities. The goal is to achieve clinical, financial,and utilization goals through effective management, communication and rolemodeling. The Manager functions as theinternal resource on issues related to the appropriate utilization of resources,coordination of care across the continuum and Utilization Review andmanagement. Successful candidates in this role will:

• Complete daily reviews on all patients and oversees the communication of those reviews to all requesting insurance companies per agreement
• Update the Utilization Review Plan to meet CMS requirements for CoP
• Receive all denials for care involving patient stays. Manages all appeals related to denials of patient stays for all payer/insurance companies
• Participate in quality improvement processes and assures implementation of regulatory standards
• Research interdepartmental problems/issues and takes corrective action in timely manner and promotes respectful responsive communication between departments to promote patient centered care
• Oversee and perform concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in the patients' medical record
• Coordinate and supervise all activities of the Utilization Review Department
• Identify problems related to the quality of care and refers them to the Quality Department
• Maintain communication with the Social Service Department to facilitate timely discharge planning
• Effectively work with large amounts of confidential data and protected PHI
• Ensure that all continued stay, concurrent review and Utilization Review activities are carried out in accordance with facility policy, evidence-based industry standards and applicable laws or regulations

You could be a great fit if you have these things -

• Ability to be empathetic
• Excellent verbal and written communication skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Proficient with Microsoft Office Suite or related software
• Ability to effectively utilize electronic medical records software
• Reliable source of transportation required

BENEFITS:
All of our employees are valued and receive a competitive hourly rate; full time team members are also offered a comprehensive benefit package which includes:

• Medical, Dental, Vision, Life and Disability Insurance/ Flexible Spending Accounts
• Tuition Reimbursement & Nursing Loan Repayment Programs
• 401(k)
• Paid Time Off
• New Pet InsuranceDiscount available
• DailyPay option available! - Get your pay, when you need it
• Purchasing Power - online purchase/payroll deduction
• Tickets at Work - entertainment ticket discounts
• Employee Assistance Plan - easy-to-use services to help with everyday challenges of life (available for all employees and their families)
• Helping Friends Foundation - our employees' hardship/crisis fund
• Farmers GroupSelect Auto and Home Insurance - employee discount available - payroll deduction!
• In-facility education programs and more!

Central Desert Behavioral Health Hospital- 1525 N. Renaissance Blvd NE, Albuquerque, NM 87107
Central Desert Behavioral Health Hospital is a 64-bed inpatient hospital offering advanced programming and services for the treatment of behavioral health illness for older adults.
*Equal Opportunity Employer. M/F/Vets/Disabled. Drug-free/Smoke-free work environment.