Utilization Review Manager - Home Care jobs in Fort Lauderdale, FL

Utilization Review Manager – Exact Billing Solutions
Lauderdale Lakes, FL

About Exact Billing Solutions

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.

Leadership Opportunity

If you're experienced in healthcare management with knowledge of utilization review and you're looking for something different from the same old hospital/clinic routine, you could be our Utilization Review Manager.

This role involves implementing strategies to optimize the use of resources while maintaining high-quality care and compliance with industry standards. The Utilization Review Manager collaborates with various departments, including medical staff, finance, case management, and quality assurance, to achieve optimal patient outcomes and financial performance.

What You’ll Do

• Strategic Planning: Develop and implement the organization’s utilization review strategy to ensure the efficient and effective use of resources while maintaining compliance with regulatory guidelines.
• Policy and Procedure Development: Create, update, and enforce utilization review policies and procedures, ensuring they align with industry best practices and regulatory requirements.
• Team Management: Lead the utilization review team, providing guidance, support, and training to ensure a high level of performance and productivity.
• Quality Assurance: Monitor the quality and accuracy of utilization reviews conducted by the team to guarantee adherence to established standards and identify improvement opportunities.
• Performance Metrics: Establish KPIs for the utilization review process and regularly evaluate team performance against these metrics.
• Collaboration: Work closely with medical staff, case managers, insurance providers, and other relevant stakeholders to develop care plans and review utilization decisions.
• Compliance: Ensure compliance with all applicable laws, regulations, and accreditation standards related to utilization review, such as those set forth by government agencies and industry bodies.
• Data Analysis: Use data and analytics to identify trends, patterns, and opportunities to enhance utilization review processes, cost-effectiveness, and patient outcomes.
• Budget Management: Collaborate with finance and senior management to effectively develop and manage the utilization review department’s budget.

Education/Experience and Other Requirements

• Bachelor's degree in healthcare administration or related field (Master’s degree preferred).
• 4 years of experience in utilization review or a related healthcare management role.
• 4 years of behavioral health experience (preferred).
• Willingness to submit to drug and background screenings
• Certifications in utilization review (e.g., URAC) are advantageous.

Expertise Needed

• Knowledge of healthcare regulations, reimbursement practices, and utilization review principles.
• Strong leadership skills with the ability to inspire and motivate teams.
• Excellent communication and interpersonal abilities to collaborate effectively with stakeholders.
• Analytical mindset with the ability to use data-driven insights to inform decision-making.

Benefits

• 15 days of PTO per year (increases with tenure by company policy).
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• Medical, dental, vision, long-term disability, and life insurance.
• 401(k) program with generous employer match up to 6%.

Exact Billing Solutions Culture

Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it’s people, not numbers, that drive our success.