Utilization & Review Clinician (MSW)

UHS • Sacramento, CA

4d • Onsite

About The Position

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.

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.
• MSW degree
• Trained in Handle with Care (HWC) within the first 30 days of employment. Training provided by HOH.
• CPR certification required.

Nice To Haves

• Prior experience with prior authorizations or Case Management is preferred.

Responsibilities

• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level