Responsible for the coordination and direction of all utilization management activities to support and implement the goals of the utilization management program and plan. Participates in the department's performance improvement and continuous quality improvement (CQI) activities.
Recruits, hires, trains, evaluates, counsels technical and professional personnel performing utilization management activities.
Develops and implements policies and procedures to support the utilization management processes as out-lined in the utilization management program plan.
Functions as a resource individual to assist with or manage resolution of utilization management issues.
Prepares monthly reports of utilization management activities with statistical analysis performed.
Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy
Communicates with clinicians regarding discharge issues relevant to patients pay source. Tracks due dates for authorization reviews and alerts clinicians
Communicates with clinicians regarding admissions and discharges to various units
Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements in order to increase authorizations
Masters degree in related field from an accredited university
LPC or LCSW licensed in the state of Oklahoma
Ability to effectively communicate in English; both verbally and in writing