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Utilization Management Behavioral Health

, South Carolina

Utilization Management Behavioral Health

  • R-0000062309
  • Remote
  • South Carolina
  • Healthcare Support
  • Clinical & Research Support Services
  • Full Time
  • Hospital Authority (MUHA)
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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

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