Manager of Utilization Review

Location: Pennsylvania-Philadelphia - Eagleville
Duration: Full Time
Job ID: 20-11173 (22521562)
Category: Risk Management RN Job
Company: ProEnlist
Contact: April Estes    Call: 7204392609
Practice Type:   Hospital
Job Salary:   Competitive
Job Posted: 01/26/21

Manager of Utilization Review - 20-11173 (22521562)

Position Overview:
The Manager of UR will work in partnership with the Director of UR to ensure that utilization management activities are completed accurately, timely, and in compliance with regulations.  Addiction therapy setting. 

Responsibilities:

  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Secures necessary data for extended stay reviews.
  • Presents patients progress and clinical course of treatment, to all various insurance companies and /or their contractual agencies, to justify continued treatment and secure authorization
  • Reviews length of stay for Medicare patients.
  • Communicates all extensions of treatment to clinical teams and Director of Utilization Review.
  • Notifies clinical teams of need for current documentation.
  • Refers cases to Director of Utilization Review when appropriateness of and necessity of extended stays are questionable.
  • Interviews patients when necessary to obtain clinical justification for treatment.
  • Enters all patient authorizations into Affinity to insure proper billing
  • Attend the daily treatment team meeting on acute psychiatric unit.


Required Qualifications: 

  • Must have 3-5 years previous experience
  • Previous supervisory experience
  • Must possess knowledge of UR, insurance and managed care procedures related to a health care environment, specifically behavioral health.
  • Ability to work well with cross-functional teams
  • Comfortable working with all levels of an organization, including the ability to communicate with physicians to acquire proper documentation