Manager of Utilization Review
On-siteFranklin, Tennessee, United States
Job Summary
Manage daily operations of utilization review practices, ensuring timely initial, concurrent, and retrospective reviews with high accuracy. Lead Utilization Review Coordinators through hiring, onboarding, coaching, and supervision while performing regular audits to maintain quality and performance. Collaborate with the Director of Utilization Review to optimize processes, support denial prevention strategies, and address challenging cases that block access to care. Communicate effectively with multidisciplinary teams, insurance organizations, and external partners to provide accurate clinical information. Maintain strict confidentiality and adhere to all compliance standards while tracking performance metrics to support organizational goals.
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
- High level of collaborative skills working with a variety of groups
- Excellent interpersonal and relationship building skills
- High level of follow-through and attention to detail
- Excellent verbal and written communication skills
- Proficiency with technology resources to include Microsoft Office programs
- Clearance of pre-employment tests
- Any other mandatory state/federal requirements
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