Utilization Review Specialist MSW
Utilization Review Specialist MSW
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1 Vacancy
Job Description
Job Summary
Provides health information interacts and acts as a resource for providers for complex clinical situations to ensure appropriate use of preservice and concurrent acute medical and/or behavioral health care services. Assesses appropriateness of preservice and concurrent requests for admissions and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides financial and utilization management information to other members of the care facilitation teams for work prioritization. Works closely with inpatient care facilitators Medical Social Workers home health agencies and providers to move patients through the continuum appropriately. Medical necessity reviews for designated services are completed for all Priority Health plans.
Essential Functions
Assesses and interprets clinical information and assists in case management of complex patient population through use of independent judgment mature problem solving skills and guidelines for appropriateness of acute care setting upon admission and continued stay.
Ensure documentation and processes are consistent with regulatory standards
Communicates with physicians medical social workers and other hospital personnel concerning change in level of care on the medically complex patient population.
Makes recommendations and discusses alternatives.
Provides financial and health information to other facilitation team members for work prioritization. Communicates and collaborates with physicians and members of the team to ensure continuity and coordination of services.
Documents any instances where services were delayed inappropriate refused complicated for resource management functions.
Identifies quality indicators to facilitate process improvement and physician education.
Ensure members are authorized for the most appropriate level of care and services based on internal and external guidelines.
Collaborates with Medical Directors
Qualifications
Required
Bachelors Degree in Nursing or a health care related field
Masters Degree Masters in Social Work
2 years of relevant experience acute care clinical nursing preferably multiple clinical settings or related experience Required
5 years of relevant experience post licensure related experience in acute care clinical nursing multiple clinical settings or behavioral health with utilization management discharge planning designing patient centered care plan or related work
Registered Nurse in the State of Michigan Or Master Social Worker from the State of Michigan
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1239 E Beltline - Grand RapidsDepartment Name
PH - Behavioral HealthEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8:00 a.m. to 5:00 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
