Utilization Review Specialist
Utilization Review Specialist
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Job Description
Coachella Valley Behavioral Health a new premier inpatient treatment center for adults age 18 and older is opening soon and will set the standard for nursing care in behavioral health. Our 80bed hospital offers comprehensive training dynamic leadership and personalized support so you can achieve your greatest potential.
The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities of this role include:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization noncertified days (including identified causes and appeal information) discharges and quality of services as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with precertifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements continued stay criteria and medical necessity updates.
Education Experience & License Requirements:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associates Bachelors or Masters degree in Social Work Behavioral or Mental Health Nursing or a related health field.
- Experience: Clinical experience is required or two or more years experience working with the facilitys population. Previous experience in utilization management is preferred
- Preferred Licensure: LPN RN LMSW LCSW LPC LPCI
Job Type: Parttime
Pay: $32.00 $36.50 per hour
Expected hours: 24 per week
Expected Schedule: Saturday to Monday 8:30 AM to 4:30 PM
Benefits:
- 401(k) with matching
- Employee assistance program
- Paid time off
- Professional development assistance
- Tuition reimbursement
Required Experience:
Unclear Seniority
Employment Type
Hourly
