Utilization Review Director
Current* Manage team of seven Utilization Review coordinators* Oversee all Utilization Management functions for an acute inpatient behavioral health facility* Complete clinical pertinence reviews with Pennsylvania Medicaid to obtain authorization for services rendered* Census management including, but not limited to, the review of authorizations obtained and documentation to substantiate certifications received by external review organizations.* Denial log tracking and submission of medical necessity appeals * Oversee the completion of local coverage determination audits to ensure the facility is meeting CMS requirements and report data results to the Department of Risk Management and Performance Improvement* Build and maintain the facilities Utilization Management Committee
