Utilization Review Specialist LVN

Bakersfield Behavioral Healthcare Hospital•Bakersfield, CA

2d•Onsite

About The Position

Bakersfield Behavioral Healthcare Hospital (BBHH) is seeking a Utilization Review Specialist LVN to join their team. BBHH is an acute psychiatric and behavioral hospital offering inpatient and outpatient services for various mental and behavioral health needs. The hospital emphasizes a positive workplace culture, encouraging individual growth and development, and operating with CARES values (Compassion, Acceptance, Respect, Empowerment, Sincerity). This role is crucial in ensuring patients receive necessary care by managing insurance benefits, authorizations, and denials. The position requires critical thinking, teamwork, and strong communication skills in a fast-paced environment.

Requirements

High School Diploma
Current and unencumbered California LVN License
Previous experience in a mental healthcare hospital environment focusing on human behavior, psychiatry, psychology, or other mental healthcare situations is preferred for shortlist consideration.

Nice To Haves

Associate Degree preferred
Utilization Review experience, preferably in a behavioral/psychiatric healthcare setting or similar type of organization.

Responsibilities

Review medical records and prepare clinical appeals for medical necessity, level of care, length of stay, authorizations, and denials.
Contact external case managers and managed care organizations for certification and recertification of insurance benefits.
Assist the treatment team in understanding insurance company requirements for continued stay and discharge planning.
Communicate with the treatment team to gain a thorough understanding of the patient's treatment.
Advocate for patient access to services during treatment team meetings and through individual physician contact.
Chair treatment team meetings and continued stay reviews as indicated.