Job Description

Job Summary:

Under administrative direction, to plan, organize, and supervise the utilization review clinical program and related functions; and to perform related duties as required.  This position is responsible for assuring that all clients’ patients and providers’ needs are me.  Activities implemented are to facilitate the clinical review of any clinical request utilizing pre-approved criteria in compliance with contracted Client's requirements.  The supervisor of clinical services, under the direction of the Senior Director of Clinical Services, supervises the Clinical Therapy UM Staff and provides them with leadership to ensure high quality results.

Essential Functions & Responsibilities

·         Supervise all speech, occupational and physical therapy reviewers including assigning, reviewing, and evaluating work; interviews and recommends staff to be hired, counsels and disciplines staff, works with staff to develop and implement new and changed systems.  Prepares and monitors budgets for programs; develops and reports on performance measures.

·         Assist with managing workload given to therapy consultants

·         Maintain, train, orient, mentor and evaluate staff

·         Provide ongoing eduction and coaching to staff

·         Manage on call schedule for staff

·         Lead Monthly staff meetings

·         Meet with Individual staff (at least every other month)

·         Hold Quarterly calibration meetings per specialty

·         Monitor and approve staff PTO

·         Monitor daily workload and case distribution of staff

·         Carry ~25% case load of a full time therapy reviewer

·         Answer daily staff questions

·         Audit staff cases at least quarterly and assist with Inter-relator reliability reports

·         Ensure all cases are processed timely

·         Review and run any required daily reports

·         Assist with external Health Plan audits

·         Point person to attend meetings when a therapy reviewer is needed

Required Education and Experience

·         Required: Bachelors degree

·         Recommended:  Masters or Doctor

At least 3 years of experience in a managed care setting, CPT IDC 10, Medicare and Medicaid requirements 

Certtificates/Licences Requirement

A Clinical license required in either field of:

·         Physical, Occupational, Speech Language Pathology or Registered Nurse