Utilization Management/Admissions Manager

Job Details

Description

Manager Utilization Management and Admissions Dept

GENERAL DESCRIPTION: Direct and manage the day-to-day operations of the Utilization Review and admissions department.

Minimum Education/Experience/Skills

• Bachelor's Degree in clinical field or nursing, required. Master's Degree in clinical field preferred. 2 or more year's clinical experience with the population of the facility, previous experience in utilization management preferred.
  
  

Licenses/Designations/Certifications

• Current licensure current clinical professional license or certification, as required, within the state where the facility provides,
• LPN or RN within the state where the facility provides services;
  
  

ESSENTIAL FUNCTIONS: Are determined by the facility and may Include, but are not limited to the following:

• Monitor utilization of continuum services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.
• Responsible for the concurrent and retrospective review for all patients,
• Act as a liaison between Medicaid reviewers/gatekeepers and the staff completing required paperwork to facilitate the Utilization Review and admissions process,
• Work with physicians, therapist and nursing staff to provide optimal review based on patient
• Work with ancillary services in order to prevent delays in
• May review charts, make necessary recommendations to the physicians, In regard to utilization review and specific managed care issues.
• Assist Director with managing the Um and admission dept. staff
• Provide oversight and direction to utilization
• Demonstrates customer service behaviors when interacting with patients, team members and guests.
• Communicates patient information in a concise, accurate, timely, and
• confidential manner.
• Utilizes available resources to assist with communication needs
• Ensures that accurate Information is communicated in a timely and effective manner throughout the hospital.
• Maintains a collaborative relationship with other
  

Professional Image And Behavior

• Adheres to the department hospital code
• Focuses on the needs of the patients and
• Avoids discussion of personal issues and/or complaints in the presence of the
• Assumes responsibility for behaviors and actions; accepts constructive criticism
  
  

in a positive manner.

• Participates in opportunities to promote professional
  
  

Other Functions

• Performs other functions and tasks as assigned/needed.
  
  

Communication

• Uses language that is .. easily understood and appropriate for the specific