Utilization Review Manager

Your experience matters

At Sycamore Springswe are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and your role youll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our addition to your base compensation this position also offers:

• Health (Medical Dental Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program mental physical and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

About Us

People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette IN and is part of Lifepoint Health a diversified healthcare delivery network committed to making communities healthier with acute care rehabilitation and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters

How youll contribute

The responsibility of the UR Manager is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification peer to peer process and appeals. The UR Manager will report consistently and accurately to the Director of Finance the authorization status of current patients and appeals.

Essential Functions:

• Oversees the UR department ensuring staff has completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the Director of Finance or delegate.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with clinical services team to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations external reviews and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

Qualifications and requirements

Education: Bachelors degree required. Masters degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred. Leadership experience required.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPI and HWC certification required.

EEOC Statement:

Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.