As the Utilization Manager, review the medical necessity of patient admissions, extended stays, and the professional services rendered including the provision of drugs and biologicals on a case-by-case basis.
location: West Palm Beach, Florida
job type: Permanent
work hours: 9 to 5
education: Associate's degree
experience: 2 Years
The Utilization team leader will direct, coach and mentor the staff to ensure there is timely and effective communication of information between the clinical staff and billing staff. Perform reviews of all admissions to the inpatient programs, and oversee admissions to other clinical programs as indicated to determine clinical necessity and appropriateness in accordance with approved criteria, standards, or policy and procedure. Work with insurance companies to obtain pre-certification for admissions and authorizations for continued stays.
2-3 years of utilization experience in a mental health/hospital environment
skills: Medical Terminology
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.