Manager of Utilization Review
On-siteFranklin, Tennessee, United States
Job Summary
Manage daily operations of Utilization Review practices for an assigned division, ensuring timely initial, concurrent, and retrospective reviews are conducted efficiently with high accuracy. Lead hiring, onboarding, coaching, and supervision of Utilization Review Coordinators while performing medical records reviews and regular audits to maintain quality and performance. Collaborate with leaders across clinical, revenue cycle, and admissions teams to support denial prevention, regulatory compliance, and process optimization. Escalate challenges to the Director of Utilization Review as needed and maintain strict confidentiality for all client and provider information. Requires a bachelor's degree, three years of experience in mental health or substance abuse facilities, and proficiency with Microsoft Office.
Required Qualifications
- Bachelor's degree or equivalent in combined education and experience
- Minimum of three (3) years' experience with external review organizations or comparable entities doing pre-certification and concurrent reviews in mental health, substance abuse, and/or eating disorder facilities
- Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using established facility criteria
- Proficient knowledge of medical and behavioral health terminology, and techniques used to diagnose and treat various medical conditions
- Demonstrated ability to successfully function under pressure in critical situations
- Demonstrated ability to effectively manage conflict and crisis situations
- Strong problem solving and analytical skills
- Ability to consistently exercise sound judgment and a high level of discretion
- Excellent organizational and time management skills
- Excellent verbal and written communication skills
- Proficiency with technology resources to include Microsoft Office programs
- Clearance of pre-employment tests, and any other mandatory state/federal requirements
Desired Qualifications
- Demonstrated ability to effectively lead and coach others
- High level of collaborative skills working with a variety of groups
- High level of follow-through and attention to detail
- Consistently demonstrates and models alignment with company core values and mission
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