Under minimal supervision andin a professional and friendly manner, this position has the responsibility forthe day to day operations of the Support Services - Utilization ManagementInpatient Services with the guidance of the Manager of Utilization Management, InpatientServices.The incumbent shall plan,organize, direct and evaluate people and activities for the department tomaximize daily inpatient prior authorization for non-clinical support servicesto minimize denial activity for MHS. The position requires working with PatientAccess Leaders, PFS, Inpatient Case Management Leaders and other identifiedleadership to achieve the overall strategic goals of the department as itrelates to the cost-effective utilization management processes that supportspatient care, maximizing the revenue cycle rendered by providers and theirpatients within all MemorialCare Hospitals.
Principal Duties and Responsibilities
The Supervisor, Support Services - Utilization ManagementInpatient Services reports to the Manager of Utilization Management, InpatientServices for establishing, maintaining and continuously improving processesrequired to achieve the defined scopes of support services that arenon-clinical for Inpatient utilization management as well as direct managementand training of the Support Services for Inpatient Utilization Management team allMemorialCare hospitals.
Adding to the generalfiscal health of MHS entities as subject matter expert for authorization,billing compliance and appeals processes by promoting utilization management processes thatprovide authorizations, eligibility, benefits and billing compliance
Responsible for managing the Support Services-UtilizationManagement Inpatient Services team which may include, but not limited to thefollowing positions: Utilization Review Assistant, Utilization ReviewSpecialist and Data Coordinator.
Formalize administrative care coordination and utilizationmanagement processes, roles, team evaluations, policy and procedures, and continuouslyupdate documents as improvements are implemented under the guidance of the Managerof Utilization Management, Inpatient Services and Executive Director,Utilization Management.