Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodation may be made to enable an individual with disabilities to perform the essential job responsibilities.
LSM Values: We at LSM Chiropractic are fueled by the energy of our team. We promote a culture where team members take initiative in job performance, problem solving and in setting and achieving goals.
While we insist on respect for patients and fellow team members, we also encourage an environment full of camaraderie and laughter. We strive to inspire our patients and our team members to live a healthy life.
General Description: The primary responsibility of this position is to perform the insurance and prior authorization functions of the Revenue Cycle Department ensuring accurate coverage information is entered for billing processing.
Essential Job Responsibilities:
Patient Support: Provide insurance and billing information to patients and other LSM employees. This may involve explaining LSM policies, insurance procedures, and offering other support as needed.
Identify and verify patient benefits for the clinics and post benefit information to the patient’s account in the database, as well as communicate the information to the appropriate clinic as necessary.
Prior Authorization and Utilization Review: Submit timely prior authorization requests, review utilization and service counts of service requests, and coordinate with front office clinic staff to support required medical records requests from patients.
Credentialing: Maintain accurate records and submit applications for provider credentialing to payors for which LSM is contacted.
Billing Task Support: Support the review of patient and insurance payment review as related to insurance coverage denials and other coverage related payment needs.
Confidentiality: Display a high level of integrity by maintaining confidence of proprietary information. Protect all tangible and intangible company assets including proprietary software and databases.
Additional Job Responsibilities:
· Review outgoing medical records for accuracy.
· Conduct special projects as assigned.
Required Skills and Competencies:
· High School diploma or equivalent
· 1-2 years experience in healthcare setting
· Working knowledge of health insurance information and portals
· Excellent verbal and written communication skills
· Strong customer service skills and attention to detail
· Proficient in Microsoft Office applications
Job Type: Full-time
Pay: $16.50 per hour
Expected hours: 40 per week
Benefits:
Schedule:
People with a criminal record are encouraged to apply
Education:
Experience:
Work Location: In person
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