[Hiring] Utilization Review Supervisor @Sunshine Behavioral Health

Role Description

The Utilization Review Department Supervisor serves as a role model for staff and assists in day-to-day activities, supervises and coordinates a team of UR specialists. Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Manages areas which may include authorizing inpatient admissions, outpatient services, focused out of network services, and appropriateness of treatment setting.

• Exhibit timeliness, patience, confidence, and accountability, to all departments, both internal and external.
• Provide service support and training to the team in addition to initiating and implementing process improvements.
• Assign cases to UR Reps/UR appeals specialist for initial authorizations/coverage cases.
• Determine medical necessity, level of care and appropriateness of services using clinical review criteria-based information given by providers.
• Be available and flexible with weekends and holidays for support and guidance to the team.
• Coordinate department activities: staff education, policy and procedure development and revision.
• Liaison with day-to-day productivity and communication needs amongst all departments (Admission, clinical, medical, etc).
• Co-coordinate staff meetings with UR manager, facilitate meetings as needed.
• Participate in the development and implementation of department/division projects.
• Maintain the role of UR specialist with a reduced caseload for SUD and MH.
• Communicate necessary information with management and billing to ensure a seamless revenue cycle, along with all UR specialists and other departments as necessary.
• Maintain up to date knowledge of insurance payer requirements.
• Keep current and accurate documentation in Salesforce and EMR systems as well as ensuring accurate documentation and management of information from UR specialists.
• Other duties as assigned include and are not limited to providing admissions with guidance on Authorizations for a potential client and any risks of admission to specific levels of care.
• Knowledge of Federal policies specifications for all facility states and future facilities.
• Assist manager with creating and maintaining a positive work culture and growth.

Qualifications

• Bachelor’s degree in psychology, Mental Health Counseling, Social Work or another related field.
• Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual).

Requirements

• Five (5) years’ experience in chart analysis and utilization review in the psychiatric and chemical dependency field preferred.
• Exceptional oral and written communication skills required to communicate in a clear and concise manner with patients, physicians, staff, and administration along with the ability to positively influence others with respect and compassion.
• The ability to manage emotions and impulses and present calmly while working in a fast-paced environment with frequent interruptions.
• Strong work ethic built on a foundation of proactivity and teamwork.
• Ability to navigate ambiguity with the aid of structured problem-solving techniques.
• Computer proficiency in Microsoft Office.

Physical Requirements

• During remote work, employee is responsible for ergonomic requirements and a work area free from distractions.
• Role is performed using computer (including screen, keyboard, mouse, etc), phone, and other typical office equipment.
• Significant phone work including talking and listening.
• Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Work Location

Remote