Utilization & Review Clinician (MSW)

UHS•Sacramento, CA

About The Position

Heritage Oaks Hospital is part of the UHS Family of Providers which has been highly regarded as an integral part of the greater Sacramento and Northern California mental health system since 1988. Conveniently located in northern Sacramento, Heritage Oaks is a fully accredited, 125-bed acute psychiatric hospital offering a full range of individually tailored treatment services to adolescents, adults, and senior adults, including treatment for substance abuse and chemical dependency issues with drugs and alcohol. Heritage Oaks is a Medicare provider in addition to contracts with most commercial health insurance plans. Heritage Oaks has three outpatient centers as part of the Branches Outpatient of the greater Sacramento. Providing partial hospitalization programs (PHP) and intensive outpatient programs (IOP) to support patients on their road to wellness. We are committed to providing service excellence to all and ensuring our patients receive the optimal level of care that will be most beneficial to their health and recovery. Website: https://heritageoakshospital.com/ The Utilization Review Clinician is responsible for the managing, reviewing and monitoring the utilization of resources related to the patient and to maximize effectiveness of care by evaluating clinical appropriateness. The Utilization Review Clinician functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement. The UR Clinician will also review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review. Works cooperatively with Assessment & Referral in establishing clinical pre-authorization. Communicates with the business office regarding any information pertaining to insurance benefits and coverage. Attend treatment planning meetings and oversee the coordination of care for patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial. Heritage Oaks offers comprehensive benefits such as: Competitive Compensation Excellent Medical, Dental, Vision, and Prescription Drug Plan Generous Paid Time Off 401(K) with company match and discounted stock plan Career development opportunities within UHS and its Subsidiaries Education Assistance Challenging and rewarding work environment

Requirements

Master’s degree in social work, mental health or a related field.
A minimum of one (1) year experience with communication with external review organizations or comparable entities or four (4) years direct clinical experience in a psychiatric or mental health setting.
Prior experience with prior authorizations or Case Management is required.
MSW degree
Trained in Handle with Care (HWC) within the first 30 days of employment. Training provided by HOH.
CPR certification required.

Responsibilities

managing, reviewing and monitoring the utilization of resources related to the patient and to maximize effectiveness of care by evaluating clinical appropriateness
functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement
review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review
Works cooperatively with Assessment & Referral in establishing clinical pre-authorization.
Communicates with the business office regarding any information pertaining to insurance benefits and coverage.
Attend treatment planning meetings and oversee the coordination of care for patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial.