Utilization Management Behavioral Health

Job Description Summary Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type​ Regular Cost Center CC005263 SYS - MH ICCE State Appropriation Pay Rate Type Salary Pay Grade Health-28 Scheduled Weekly Hours 40 Work Shift Job Description Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required. Additional Job Description Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required.   Physical Requirements  Mobility & Posture  Standing: Continuous  Sitting: Continuous  Walking: Continuous  Climbing stairs: Infrequent  Working indoors: Continuous  Working outdoors (temperature extremes): Infrequent  Working from elevated areas: Frequent  Working in confined/cramped spaces: Frequent  Kneeling: Infrequent  Bending at the waist: Continuous  Twisting at the waist: Frequent  Squatting: Frequent  Manual Dexterity & Strength  Pinching operations: Frequent  Gross motor use (fingers/hands): Continuous  Firm grasping (fingers/hands): Continuous  Fine manipulation (fingers/hands): Continuous  Reaching overhead: Frequent  Reaching in all directions: Continuous  Repetitive motion (hands/wrists/elbows/shoulders): Continuous  Full use of both legs: Continuous  Balance & coordination (lower extremities): Frequent  Lifting & Force Requirements  Lift/carry 50 lbs. unassisted: Infrequent  Lift/lower 50 lbs. from floor to 36”: Infrequent  Lift up to 25 lbs. overhead: Infrequent  Exert up to 50 lbs. of force: Frequent   Examples:  Transfer 100 lb. non-ambulatory patient = 50 lbs. force  Push 400 lb. patient in wheelchair on carpet = 20 lbs. force  Push patient stretcher one-handed = 25 lbs. force  Vision & Sensory  Maintain corrected vision 20/40 (one or both eyes): Continuous  Recognize objects (near/far): Continuous  Color discrimination: Continuous  Depth perception: Continuous  Peripheral vision: Continuous  Hearing acuity (with correction): Continuous  Tactile sensory function: Continuous  Gross motor with fine motor coordination: Continuous  Selected Positions:  Olfactory (smell) function: Continuous  Respirator use qualification: Continuous  Work Environment & Conditions  Effective stress management: Continuous  Rotating shifts: Frequent  Overtime as required: Frequent  Latex-safe environment: Continuous    If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees