Manager-Utilization Management

Sonora is the Leading Behavioral Health Hospital in Tucson, Arizona. We are looking for a knowledgeable manager to add to our Utilization Team. Successful candidates will have at least one year of managerial experience, as well as inpatient utilization review/management experience.

Manager is responsible to monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patients provider benefits for their needs.

ESSENTIAL FUNCTIONS:

• Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
• Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
• Evaluate the utilization program for compliance with regulations, policies and procedures.
• Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.