Utilization Review Manager - Home Care jobs in Florida
Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Recently Added Utilization Review Manager - Home Care jobs
Utilization Review Manager
- ABA Centers of Delaware
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Lauderdale, FL
FULL_TIME
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Brief Description
Utilization Review Manager – Exact Billing Solutions
Lauderdale Lakes, FL
About Exact Billing Solutions
Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.
Leadership Opportunity
If you're experienced in healthcare management with knowledge of utilization review and you're looking for something different from the same old hospital/clinic routine, you could be our Utilization Review Manager.
This role involves implementing strategies to optimize the use of resources while maintaining high-quality care and compliance with industry standards. The Utilization Review Manager collaborates with various departments, including medical staff, finance, case management, and quality assurance, to achieve optimal patient outcomes and financial performance.
What You’ll Do- Strategic Planning: Develop and implement the organization’s utilization review strategy to ensure the efficient and effective use of resources while maintaining compliance with regulatory guidelines.
- Policy and Procedure Development: Create, update, and enforce utilization review policies and procedures, ensuring they align with industry best practices and regulatory requirements.
- Team Management: Lead the utilization review team, providing guidance, support, and training to ensure a high level of performance and productivity.
- Quality Assurance: Monitor the quality and accuracy of utilization reviews conducted by the team to guarantee adherence to established standards and identify improvement opportunities.
- Performance Metrics: Establish KPIs for the utilization review process and regularly evaluate team performance against these metrics.
- Collaboration: Work closely with medical staff, case managers, insurance providers, and other relevant stakeholders to develop care plans and review utilization decisions.
- Compliance: Ensure compliance with all applicable laws, regulations, and accreditation standards related to utilization review, such as those set forth by government agencies and industry bodies.
- Data Analysis: Use data and analytics to identify trends, patterns, and opportunities to enhance utilization review processes, cost-effectiveness, and patient outcomes.
- Budget Management: Collaborate with finance and senior management to effectively develop and manage the utilization review department’s budget.
Education/Experience and Other Requirements- Bachelor's degree in healthcare administration or related field (Master’s degree preferred).
- 4 years of experience in utilization review or a related healthcare management role.
- 4 years of behavioral health experience (preferred).
- Willingness to submit to drug and background screenings
- Certifications in utilization review (e.g., URAC) are advantageous.
- Knowledge of healthcare regulations, reimbursement practices, and utilization review principles.
- Strong leadership skills with the ability to inspire and motivate teams.
- Excellent communication and interpersonal abilities to collaborate effectively with stakeholders.
- Analytical mindset with the ability to use data-driven insights to inform decision-making.
Benefits- 15 days of PTO per year (increases with tenure by company policy).
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
- Medical, dental, vision, long-term disability, and life insurance.
- 401(k) program with generous employer match up to 6%.
Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it’s people, not numbers, that drive our success.
- 4 Days Ago
UTILIZATION REVIEW MANAGER
- Suncoast Behavioral Health Center
-
Bradenton, FL
FULL_TIME
- Responsibilities: Suncoast Behavioral Health Center opened its doors in 2014 and provides the highest quality of behavioral healthcare for patients in a safe, secure and nurturing environment. Suncoas...
- 9 Days Ago
Utilization Review Manager
- ICBD HOLDINGS LLC
-
Lauderdale, FL
FULL_TIME
- Utilization Review Manager – Exact Billing Solutions Lauderdale Lakes, FL About Exact Billing Solutions Exact Billing Solutions is a unique team of medical billing professionals specializing in the su...
- 1 Month Ago
Utilization Review Manager
- UHS
-
PANAMA CITY, FL
FULL_TIME
- Responsibilities Utilization Review Manager Opportunity Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama Cit...
- 1 Month Ago
Manager, Utilization Review
- Emerald Coast Behavioral Hospital
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Panama, FL
FULL_TIME
- We are seeking a dedicated Utilization Review Manager to join our team. Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facili...
- 14 Days Ago
Clinical Coding and OASIS Review Manager
- BAYADA Home Health Care
-
Orlando, FL
FULL_TIME
- Please note– Candidates must have COS–C, HCS–O or COQS and HCS–D or BCHH–C in order to be considered, there is no flexibility around this requirement. BAYADA Home Health Care has an immediate opening ...
- Just Posted
Utilization Review Manager - Home Care jobs at Popular Companies
Gas Utilities Manager
- Accenture
-
Austin, TX
- We Are: Our Utility Industry, Transmission & Distribution Practice is powering the progress to a safe, connected, and su...
- 6/10/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System, Inc.
-
Beaver, PA
- Department: Utilization Review. Work Hours: Primarily Monday through Friday, extended hours as needed to support organiz...
- 6/9/2024 12:00:00 AM
Supervisor, Utilization Management
- Centene Corporation
-
Tallahassee, FL
- You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Managem...
- 6/9/2024 12:00:00 AM
Utilization Management Specialist
- Blue Cross and Blue Shield Association
-
Meridian, ID
- Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, pri...
- 6/9/2024 12:00:00 AM
Director of Utilization Management
- Oceans Healthcare
-
Jackson, MS
- Description The Director Utilization Management is responsible for oversight and management of all utilization review/ca...
- 6/8/2024 12:00:00 AM
Manager, Utilization Management
- Hiring Now!
-
New York, NY
- Creates and upholds policies and procedures for coverage determinations. Serves as subject matter expert for Medicare co...
- 6/8/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System
-
Beaver, PA
- Department: Utilization Review Work Hours: Primarily Monday through Friday, extended hours as needed to support organiza...
- 6/7/2024 12:00:00 AM
Environmental and Utilities Manager
- Leprino Foods
-
Lubbock, TX
- For our future state-of-the art 600+ person Lubbock, TX cheese and whey manufacturing facility, Leprino is seeking an En...
- 6/6/2024 12:00:00 AM
About Florida
Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$72,753 to $92,748