Utilization Review Manager - Home Care jobs in Texas

Overview

Carrollton Springs 

 Utilization Review Manager

Carrollton Springs is a 78-bed behavioral hospital located near Carrollton, TX . The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Carrollton Springs we are dedicated to Changing People’s Lives®."

The Utilization Review department plays an essential role in helping fulfill our mission of “Changing People’s Lives®”.  Utilization Review team members advocate on behalf of our patients to managed care providers for necessary treatment.  As a Utilization Review Specialist, you will accurately and timely complete utilization review activities.

Members of our team Enjoy:

• Working with a highly engaged staff
• Healthy staffing levels
• Flexible scheduling
• Career growth
• Competitive compensation

• UKG Wallet – We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own schedule.

Position Details

• Oversees the Utilization Review department, ensuring staff has completed all assignments and monitors performance.
• Acts as a liaison between managed care organizations and the facility’s behavioral health clinical treatment team.
• Conducts clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
• Monitors patient length of stay and conducts initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
• Facilitates peer to peer reviews between the facility treatment provider and the managed care physician.
• Assists the Assessment Department with completion of the precertification process for admissions.
• Provides ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.

Qualifications

Qualifications:

• Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment.
• Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers.
• Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team.
• Strong computer skills and ability to navigate electronic systems applicable to job functions.

Requirements:

• Bachelor’s degree or current clinical license strongly preferred
• CPR and CPI Certification within 30 days of employment

Experience:

• Previous utilization review experience in a psychiatric healthcare facility preferred
• Education and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field