Utilization Review Specialist LVN

Bakersfield Behavioral Healthcare Hospital•Bakersfield, CA

3d•Onsite

About The Position

Bakersfield Behavioral Healthcare Hospital (BBHH) is an acute psychiatric and behavioral facility offering inpatient and outpatient services for children, adolescents, and adults. BBHH is committed to being a top workplace by offering excellent benefits, fostering individual growth, and integrating its CARES values (Compassion, Acceptance, Respect, Empowerment, Sincerity) into daily operations. The facility is a fast-paced environment that requires critical thinking, leadership, teamwork, and communication skills. The Utilization Review Specialist plays a key role in ensuring patients receive appropriate care by reviewing medical records, preparing clinical appeals, coordinating with external case managers, and advocating for patient access to services.

Requirements

High School Diploma
Current and unencumbered California LVN License

Nice To Haves

Associate Degree preferred
Previous experience in a mental healthcare hospital environment focusing on human behavior, psychiatry, psychology, or other mental healthcare situations.
Utilization Review experience preferably in a behavioral/psychiatric healthcare setting or similar type of organization.

Responsibilities

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