Utilization Department Head

Utilization Department Head

Utilization Department Head (UR Manager) Job Description

Summary: The Utilization Department Head is responsible for the overall management and timely submission of all client service authorizations, ensuring compliance with payer requirements (RBHS and OPT) to prevent revenue denials. This role requires strong leadership to supervise the Utilization Authorization staff and significant collaboration with internal teams to identify and correct front-end authorization issues that contribute to bad debt.

🔑 Key Responsibilities and Duties

1. Authorization Management and Compliance

• Timely Submission: Ensure all re-authorizations (90-day submissions) are submitted promptly, with a mandatory deadline of 14 days prior to the authorization lapse date.
• Authorization Tracking: Track and manage all authorizations for both RBHS (Rehabilitative Behavioral Health Services) and OPT (Outpatient Treatment) services.
• Clinical Collaboration (RBHS): Submit the list of expiring RBHS authorizations to the Clinical Director one month prior to the lapse date to ensure clinical documentation is completed for timely submission.
• OPT Coordination: Work directly with the Sagar (Insync) team to coordinate and manage OPT authorizations.
• EHR Data Entry: Ensure all new authorizations are entered into the Insync EHR system within 48 hours of receiving the faxed documentation.
• Crisis Management: Manage the Suicide/Homicide (SH) crisis post-authorization process.

2. Process Improvement and Denial Prevention

• Interdepartmental Collaboration: Collaborate with the Bad Debt team (which includes Cheryl Macias from QA and Christina Ryan from Corporate Billing) to analyze denial data.
• Front-End Correction: Identify and implement corrective actions for front-end issues related to authorizations that are causing service denials.
• Ultimate Responsibility: While specific tasks may be assigned to Utilization Authorization staff, the Utilization Department Head maintains ultimate responsibility for the successful and timely completion of all departmental functions.

3. Departmental Leadership

• Supervise and train Utilization Department Authorization staff.
• Monitor staff performance, adherence to deadlines, and quality control for all authorization submissions.

💼 Required Qualifications

• Proven experience in Utilization Review/Management within a healthcare or behavioral health setting.
• Demonstrable experience working with EHRs (Electronic Health Records).
• In-depth knowledge of SC Medicaid authorization and billing procedures.
• Proficiency with Microsoft Excel, including experience with pivot tables, for data analysis and tracking.
• Must be highly computer savvy and possess strong organizational skills.

💵 Position Details

• Compensation: $48,000 annually
• Schedule: Monday through Friday, 9:00 AM – 5:00 PM
• Work Location: In-office position

Qualifications

Salary : $48,000