Utilization Manager 9/14/2016

McLean Hospital(MCL) Middleborough, MA

Company
McLean Hospital(MCL)
Job Classification
Full Time
Company Ref #
3024952
AJE Ref #
576170720
Location
Middleborough, MA
Experience
Entry Level (0 - 2 years)
Job Type
Regular
Education
Doctoral Degree

JOB DESCRIPTION

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McLean Hospital is a comprehensive psychiatric hospital committed to providing easy access to superior quality, cost-effective mental health services in the Boston area, Massachusetts and beyond. Since 1811, McLean Hospital has been a world leader in the treatment of mental illness and chemical dependency, research into the cause of mental illness and the training of generations of mental health care providers. McLean's multidisciplinary programs treat a broad range of psychiatric illnesses across the full continuum of care.

SUMMARY:



Responsible for carrying out patient care review program which facilitates the appropriate use of resources and quality of care.

JOB RESPONSIBILITIES AND STANDARDS OF PERFORMANCE:

* Develop collaborative relationships with MCOs including participating in third party on-site visits and appeals. (20%)

* Consult to administrative/clinical staff regarding utilization management related issues. (15%)

* Participates in daily clinical rounds, or otherwise reviews cases with clinicians. (15%)

* Performs telephone reviews with managed care staff. (20%)

* Makes appropriate IDX entries and assists Patients Financial Services Department when indicated. (15%)

* Negotiates and processes single case agreements as needed. (5%)

* Participates on McLean committees and assists in CQI efforts as needed. (5%)

* Assists in developing and refining department policies and practices. (5%)

All McLean team members are expected to consistently demonstrate our values of integrity, compassion, respect, diversity, teamwork, excellence and innovation in their work activities and interactions.

EDUCATION/LICENSURE:

RN, LICSW, LMHC, Ph.D., with current Massachusetts license

SKILLS:

Excellent clinical skills. Interpersonal, communication and organizational skills plus ability to make judgments are essential.

EXPERIENCE:

Two years clinical experience, working with psychiatric in-patient population preferred. Previous utilization management experience preferred.

WORKING CONDITIONS:

Ranges from general office conditions to performing reviews on patient halls, where office amenities dont exist.



PHYSICAL AND MENTAL EFFORTS:

Requires considerable walking. Requires long periods of concentration.

All employees must possess basic computer skills to use a variety of electronic or online systems for communication, clinical and administrative purposes.

It is the policy of McLean Hospital to affirmatively provide equal opportunity to all qualified applicants for employment and existing employees without regard to their race, religion, color, national origin, sex, age, ancestry, protected veteran status, disability, sexual orientation, gender orientation or any other basis that would be in violation of any applicable law or regulation.