Manager of Admissions & Utilization Review (#RH0320)
$40.51-$49.24 Hourly / $7,021.70-$8,534.92 Monthly / $84,260.43-$102,419.08 Yearly

Under direction, manages the San Joaquin General Hospital Admitting and Utilization Review Units and does related or other work as required in accordance with Rule 3, Section 3 of the Civil Service Rules.

An employee in this class has overall management responsibility for units which provide the financial screening, pre-admitting and admitting of patients, bed control functions and utilization review activities, in the San Joaquin General Hospital.

• Plans, organizes and directs the work of a 24-hour unit engaged in financial interviewing and screening of patients to be admitted to the hospital and patients having ambulatory surgery, the establishment of payment plans, the scheduling of admissions, the maintenance of patient census data, the verification of insurance benefits and the establishment of third party coverage where none previously existed.
• Plans, organizes and directs the work of a unit engaged in utilization review activities to maximize medical services reimbursement.
• Prepares policies, procedures and forms for units' operation; develops and monitors unit budgets.
• Interprets federal and state regulations, contracts and agreements as related to utilization review and inpatient reimbursement and makes recommendations to Hospital Administration; Implements regulatory charges and confers with appropriate staff regarding impact.
• Coordinates with the Physician Chairman of the Utilization Review Committee to meet JCAHO requirements, educate physicians and other hospital staff, establish, prioritize and meet utilization review goals.
• Manages program to provide San Joaquin General Hospital patient transfer to other facilities for treatment; arranges for treatments, fee schedules and applicable contracts with these agencies.
  Interfaces with hospital physicians on financial and review requirements to maximize and protect reimbursement, keep physicians current on program requirements, avoid third party denials and assist with and assure timely appeals.
• Reviews and recommends modification of data processing utilization by the units.
• Selects, trains, supervises and evaluates assigned professional, para-professional and clerical staff.
• Prepares reports and correspondence; develops, interprets, organizes and prepares reports of hospital statistics.

Education: Graduation from an accredited four-year college or university with a major in public or business administration, health care management, social sciences or a related field.

Experience: Three years of responsible medical credit and insurance, welfare eligibility, hospital admitting or directly comparable experience, including one year at a supervisory level.

Substitution: Additional qualifying experience may be substituted for the required education on a year for year basis.

Principles of interviewing; fundamental principles of human behavior; principles and techniques of supervision and training; basic data processing concepts and functions; public relations techniques; principles and techniques of gathering and organizing data and statistical analysis; principles and practices of utilization review; basic principles and practices of public and business administration.

Schedule and assign work, train staff; establish and evaluate priorities; read, interpret, explain and apply regulations and procedures; communicate effectively; analyze situations accurately and take effective action; establish and maintain effective working relationships with patients, physicians, hospital staff, outside agencies and the general public.