Utilization Review Supervisor

The UR Supervisor is responsible to provide an oversight of third-party payer Utilization Review (UR) and the denial management (DM) process. This role will actively supervise and coordinate the front end to back denial management initiatives including Utilization review, Authorization Appeals and compliance protocols.  Providers supervision and direction for UR process along with analysis, resolution, monitoring & reporting of clinical denials.  Serves as a liaison between Case Management, Business Office and Coding teams to ensure timely reporting and tracking/follow up of denials Participate in regular Utilization committee and Came Management meeting with stakeholders from all department and Corporate leadership team to provide necessary education and discuss progress and protocols for Insurance authorization and denial prevention strategies. Performs ongoing audits to monitor UR and appeal/denial process and develops process improvement plans for identified deficiencies.  Knowledge of Federal, State and intermediary guidelines related to inpatient acute care hospitalization as well as lower levels of care for the continuity of treatment. Performs other duties are assigned.

EDUCATION, EXPERIENCE, TRAINING

St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $37.00 to $49.39. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.