Job Title: Team Leader- Utilization Review
Department
Clinical
Supervisor/Report
Clinical Manager
Job Description
The Team Leader of Utilization Review provides comprehensive management of the Utilization Review team and facilitates the delivery of quality standards for the Utilization Review Program, cost effective outcomes and operational efficiencies in clinical workflows.
Primary Responsibilities
- Leads the Utilization review team by directing the activities of team members and draws upon accreditation standards, medical necessity criteria and clinical expertise to manage all aspects of utilization review.
- Establishes goals and objectives for the UR Team and individual team member roles and responsibilities.
- Troubleshoots for problems and submits recommendations. May be required to interface with other areas, either internally or externally, to effectively resolve problems.
- Provides direct supervision of staff, including performance reviews.
- Anticipates the resolution of issues through proactive and effective communication.
- Reviews utilization data and discusses trends with the Clinical Manager and Program Director.
- Establishes and maintains an in-depth knowledge of workflows, products, program components.
- Supports the development of solutions for issues and presents recommendations to the Clinical Manager and/or Program Director.
- Assists with the design, development, modification, of workflows for the Utilization Review Team.
- Works with providers to ensure that available resources are being used in a timely and cost effective manner that lead to optimal clinical outcomes.
- Monitors daily performance to ensure business goals are met and compliance with BHS policies and procedures.
- Participates in Administrator on Call (AOC) schedule.
- Assumes other duties/projects as assigned.
Experience/Education
- Leadership skills and supervisory experience, including the ability to develop team performance.
- Excellent written and oral communication skills.
- Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.
- Demonstrated understanding of CQI.
- Ability to manage and coordinate with internal and external departments.
- Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years. A minimum of LICSW, LCSW, LMFT, RN, LMHC, with 5-7 years combined direct behavioral health, supervisory and/or managed care experience required.
Supervision Exercised
Weekly or as needed
Supervision Received
Weekly and as needed from Director of Clinical Management
Weekly and as needed from the Program Director
Working Condition
General office environment. May require time commitments beyond 40 hours per week at times.
Job Classifications
Exempt