Job Description

Granite Hills Hospital

Our new, state of the art, 120-bed inpatient facility features evidence-based treatment modalities and a multi-disciplinary team led by medical professionals.

Manager of Utilization Management

The Manager of Utilization Management/Review is responsible for overseeing the Utilization Management Program for Inpatient and Outpatient services. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payors.

• Direct the response to request for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.
• Review the effectiveness of the comprehensive interface with external reviewers, communicates with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of reviews and provide consultation as needed.
• Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.
• Assure patients are receiving effective and appropriate treatment, based on the level of care.
• Establish standards for customer relations and monitor the interactions between internal staff and customers to evaluate the effectiveness of customer service.

Qualifications: Bachelor’s degree in nursing, social work, psychology, or related field required; master’s degree preferred.  RN, LCSW, LPC or applicable license preferred. A minimum of two (2) years direct clinical experience in a psychiatric or mental health treatment setting, including one year of managing a related function preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities preferred.

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