Utilization Review Manager
Your experience matters
At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you’ll 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 team. In 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 milestone—your experience matters
How you’ll 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: Bachelor’s degree required. Master’s 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.