Utilization Manager

ARKANSAS CHILDREN'S IS A TOBACCO FREE WORKPLACE. FLU VACCINES ARE REQUIRED. ARKANSAS CHILDREN'S IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, DISABILITY, PROTECTED VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE, OR LOCAL LAWS. This position has been designated as safety sensitive and cannot be filled by a candidate who is a current user of medical marijuana. CURRENT EMPLOYEES: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/)and search the "Find Jobs" report. Work Shift: Day Shift Time Type: Full time Department: CC017217 Children's Specialty Services Summary: Arkansas Children's Behavioral Health, FT, M-F, 8a-5p Additional Information: The Utilization Manager improves overall quality of clinical documentation to ensure that information in the medical record accurately reflects client's care and progress, and thus utilization of resources. This role works with providers to correctly capture that services being delivered are medically necessary and timely. RN or LPC Required Masters Degree Required 3 years in Mental Health/ Hospital Setting Required Education: Master's degree in a related field of study. Recommended Education: Master's degree in a related field of study., Master's Degree Nursing Required Work Experience: Recommended Work Experience: Required Certifications: 1 of the following certifications is required - Recommended Certifications: Licensed Certified Social Worker (LCSW) - Arkansas Professional Board, Licensed Professional Counselor (LPC) - Arkansas Board of Examiners in Counseling, RN License (AR or Compact State) - Arkansas State Board of Nursing (ASBN) Description 1. Complete concurrent and retrospective medical record reviews to ensure services are appropriate, efficient, and compliant with payer and regulatory guidelines. 2. Process pre-authorizations and requests for services that are medically necessary and adherent to payer rules. 3. Consult with multidisciplinary team members regarding patient diagnosis, medical justification, length of treatment, and case documentation. 4. Represents the clinical and administrative team with payers for any appeals or disagreements related to care plans. 5. Provide training and education about utilization requirements to clinical and supervisory staff. 6. Demonstrate competency on mental health symptomology, treatment options and efficacies, and impact of trauma and mental health on overall well-being. 7. Participate in quality or accreditation audits to ensure program compliance on utilization review regulations. 8. Completes clinical supervision and staffing to clinicians completing their required supervision hours for full licensure, if necessary. 9. Knowledge of regulatory requirements and Arkansas laws governing services to children, adolescent and adults preferred. 10. Other duties as assigned. Arkansas Children’s is the only hospital system in the state dedicated to caring for children, which enables us to uniquely shape the landscape of pediatric care in Arkansas. Arkansas Children’s is driven by four core values—safety, teamwork, compassion and excellence—which inform every action. Arkansas Children’s Hospital has received Magnet Status from the American Nurses Credentialing Center (ANCC), for nursing excellence and patient outcomes. And we are nationally ranked by U.S. News & World Report for Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Nephrology, Neurology & Neurosurgery, Pulmonology & Lung Surgery and Urology. For more than a century, Arkansas Children’s has met the unique needs of children. But we’re more than just a hospital treating sick kids—our services include two hospitals, a pediatric research institute, foundation, clinics, education and outreach, all with an unyielding commitment to making children better today and healthier tomorrow. Arkansas Children’s Little Rock campus includes a 336-bed hospital with the state’s only pediatric Level 1 Trauma Center, burn center, Level 4 neonatal intensive care and pediatric intensive care, as well as a nationally-recognized transport service. And Arkansas Children’s Northwest provides inpatient and emergency care, clinic rooms and diagnostic services to children in that corner of the state. “Arkansas Children’s is a place of hope and comfort for children and parents. When you are at children’s, you are part of an elite team united with a common goal of saving children and making their lives better.” Michael – Business Operations Manager “Arkansas Children’s Hospital is a prestigious institution that cares for children.” Linda – Information Systems Analyst “We are an organization of care, love, and hope while we champion children.” Angela – Parking and Fleet Coordinator “Care, love, and hope for children!” Kathy – Administrative Assistant “When I think of my time here at Arkansas Children’s Hospital, I can honestly say that it has given me a unique perspective on the human condition, and the various roles that we all have in patient care. As a supply assistant, I have a very important job ensuring that the doctors and nurses have what they need to provide the world class medical care to the Children of Arkansas and surrounding states. Being a Champion for Children is more than a catch phrase, it is a way of life!” Nick – Supply Assistant