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Utilization Review Manager at Summit BHC - ApplyBlast

Utilization Review Manager

Summit BHC

5 months ago

Onsite

Full Time

Senior

0 applicants

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About this role

The Utilization Review Manager oversees the daily operations of the Utilization Management department, leading staff to review admissions and continuous stays for compliance with clinical criteria. The role involves supervising care coverage, managing insurance appeals, and analyzing patient records to optimize reimbursement while ensuring appropriate levels of care. Key activities include collaborating with admissions teams, conducting reviews, and acting as a liaison between facility staff and external reviewers.

Responsibilities

Assign clients to Utilization Review staff and supervise team performance
Direct daily department operations and manage admission coverage processes
Analyze client records to ensure compliance with insurance reimbursement policies
Appeal insurance denials and coordinate effective correspondence with payers
Collaborate with multidisciplinary teams to determine appropriate treatment lengths