Utilization Management Behavioral Health
Job Description
Summary Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC005263 SYS - MH ICCE State Appropriation Pay Rate Type Salary Pay Grade Health-28 Scheduled Weekly Hours 40 Work Shift
Job Description
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required. Additional Job Description Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required. Physical Requirements Mobility & Posture Standing: Continuous Sitting: Continuous Walking: Continuous Climbing stairs: Infrequent Working indoors: Continuous Working outdoors (temperature extremes): Infrequent Working from elevated areas: Frequent Working in confined/cramped spaces: Frequent Kneeling: Infrequent Bending at the waist: Continuous Twisting at the waist: Frequent Squatting: Frequent Manual Dexterity & Strength Pinching operations: Frequent Gross motor use (fingers/hands): Continuous Firm grasping (fingers/hands): Continuous Fine manipulation (fingers/hands): Continuous Reaching overhead: Frequent Reaching in all directions: Continuous Repetitive motion (hands/wrists/elbows/shoulders): Continuous Full use of both legs: Continuous Balance & coordination (lower extremities): Frequent Lifting & Force Requirements Lift/carry 50 lbs. unassisted: Infrequent Lift/lower 50 lbs. from floor to 36”: Infrequent Lift up to 25 lbs. overhead: Infrequent Exert up to 50 lbs. of force: Frequent Examples: Transfer 100 lb. non-ambulatory patient = 50 lbs. force Push 400 lb. patient in wheelchair on carpet = 20 lbs. force Push patient stretcher one-handed = 25 lbs. force Vision & Sensory Maintain corrected vision 20/40 (one or both eyes): Continuous Recognize objects (near/far): Continuous Color discrimination: Continuous Depth perception: Continuous Peripheral vision: Continuous Hearing acuity (with correction): Continuous Tactile sensory function: Continuous Gross motor with fine motor coordination: Continuous Selected Positions: Olfactory (smell) function: Continuous Respirator use qualification: Continuous Work Environment & Conditions Effective stress management: Continuous Rotating shifts: Frequent Overtime as required: Frequent Latex-safe environment: Continuous If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees Apply To This Job