Utilization Review Specialist

Oklahoma Department of Mental Health and Substance Abuse Services • Norman, OK

2d • $38,500 • Onsite

About The Position

The Utilization Review (UR) Specialist supports the facility’s utilization management processes. Responsibilities include preparing documentation for pre-certification of admissions and continued stays, serving as a liaison with gatekeepers, HMOs, OHCA, and insurance providers, and maintaining daily logs and tracking spreadsheets.

The UR Specialist collects and analyzes data related to medical record documentation compliance, inappropriate admissions, delays in services and discharges, premature discharges, effectiveness of discharge planning, and the over- or under-utilization of resources. The role may also involve coordinating patient transfers when appropriate.

In addition, this position contributes to quality improvement initiatives and ensures compliance with JCAHO, Title XIX, and other regulatory standards. The UR Specialist collaborates closely with the Director of Operations, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue.

The UR Specialist participates in interdisciplinary treatment teams, clinical management meetings, and agency meetings, and performs other duties as assigned. This is an on-site position that requires direct patient interaction.

Requirements

• Bachelor’s Degree in social work, psychology, or related field plus one year of technical clerical, administrative, secretarial, or general office work.
• Equivalent combination of education and experience is accepted.
• Valid driver’s license and the ability to travel as needed for job-related duties.
• Must pass pre-employment and pre-placement drug and alcohol screening due to the safety-sensitive nature of this position.

Nice To Haves

• Experience in a mental health setting.

Responsibilities

• preparing documentation for pre-certification of admissions and continued stays
• serving as a liaison with gatekeepers, HMOs, OHCA, and insurance providers
• maintaining daily logs and tracking spreadsheets
• collects and analyzes data related to medical record documentation compliance, inappropriate admissions, delays in services and discharges, premature discharges, effectiveness of discharge planning, and the over- or under-utilization of resources
• coordinating patient transfers when appropriate
• contributes to quality improvement initiatives
• ensures compliance with JCAHO, Title XIX, and other regulatory standards
• collaborates closely with the Director of Operations, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue
• participates in interdisciplinary treatment teams, clinical management meetings, and agency meetings
• performs other duties as assigned

Benefits

• Annual base salary of $38,500 plus a generous benefits allowance.
• A wide choice of health insurance plans with no pre-existing condition exclusions.
• Options for healthcare and dependent care expenses.
• 11 paid holidays, 15 days of vacation, and 15 days of sick leave in the first year.
• With a generous company match to help secure your future.
• Support when you need it.
• For years of dedicated service.
• Continuous learning and development for CEU requirements.

What This Job Offers

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