Overview This position is located at the SC Department of Behavioral Health and Developmental Disabilities (DBHDD) - Office of Mental Health – Inpatient Services, 610 Faison Drive, Columbia, SC 29203.
Are you passionate about making a real difference in people's lives? Join our team at the Office of Mental Health where we are dedicated to providing compassionate and accessible care to our community. We are seeking a Utilization Management Manager who is motivated to help individuals and families navigate life's challenges and achieve long-term wellness. If you want to use your skills to build a healthier, more resilient community, we encourage you to apply.
As the Nurse Manager, Institutional, you are responsible for the execution of the Utilization Management (UM) Plan for assigned Office of Mental Health inpatient facilities. Provide supervision to staff performing the varied functions and work processes required for execution of the Utilization Management Plan.
Responsibilities Plan, direct, and supervise daily operational procedures performed by the Utilization Management Staff. Assist UM Staff with daily work as needed in order to meet deadlines.
Monitor utilization of services and optimize reimbursement for the facilities while maximizing use of the patient's provider benefits.
Direct development and maintenance of data management and record systems pertinent to all aspects of the UM Plan. Collect and analyze utilization information to prepare monthly UM Reports for each facility. Prepare other UM/Case Management reports as warranted.
Establish and maintain effective working relationships with Office of Mental Health divisions and external agencies (CMS, Medicare and Medicaid Managed Care Organizations, KePro, Tricare, Commercial Insurance Providers, etc.).
Collaborate with appropriate individuals in the development, execution, and evaluation of the UM Plan to assure compliance with accreditation standards and regulatory requirements.
Establish and maintain Utilization Management training system for all levels of staff.
Complete mandatory training as required to include compliance and MANDT.
Qualifications Graduation from an accredited school of nursing and related nursing experience. Licensure from South Carolina State Board of Nursing.
Bachelor's of Science in Nursing with 3 years clinical experience, 2 years Utilization Management (UM) experience and 5 years' experience in supervising/managing UM Program.
Bilingual abilities in English and Spanish (or another language) are a plus.
Post hire requirements Be able to pass MANDT Certification.
Have knowledge of CMS standards and regulations; Utilization Management procedures; OMH and hospital system's mission, programs and objectives; Management principles; OMH and hospital system's organization structure and functions/processes applicable to work, to be accomplished and standard of practice and trends in health care.
Be able to review health care services to determine consistency with contract criteria.
Be able to collect and analyze data.
Be able to monitor utilization of services and optimize reimbursement for OMH.
Be able to provide oversight of the UM Department 365 days per year.
Must be able to travel among the Inpatient facilities/ OMH facilities/ sites and the municipal area.
The Department of Behavioral Health and Developmental Disabilities is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.
Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. Please complete the state application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.
The Department of Behavioral Health and Developmental Disabilities offers an exceptional benefits package for full time (FTE) employees:
Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Please note: links removed.
15 days annual (vacation) leave per year
15 days sick leave per year
13 paid holidays
Paid Parental Leave
S.C. Deferred Compensation Program available
Retirement benefit choices: State Retirement Plan (SCRS)
State Optional Retirement Program (State ORP)
*Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.