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