Utilization Review Specialist
About The Position
About the Position: Under general direction of the Director of Operations, the Utilization Review (UR) Specialist helps to manage the facility’s utilization management processes. This includes: preparing of documentation necessary for the pre-certification of admissions and extensions of hospital stays for all patients; serving as liaison with gatekeepers, HMO’s, OHCA, and insurance companies; and maintaining spreadsheets and logs daily. Elements to be included in data collection and analysis are; auditing of required medical record entries; inappropriate admissions; delays in services; delays in discharges; premature discharges; effectiveness of discharge planning; and over utilization and under utilization of resources. When appropriate, will assist with coordination of transfers. This position will also contribute to the quality improvement process as well as compliance with JCAHO, Title XIX and other regulatory standards. Will work closely with the Director of Operations and the medical, clinical and reimbursement staff to reduce the potential loss of collections. The UR Specialist will participate in interdisciplinary treatment teams, clinical management meetings, agency meetings, and other duties as assigned. This position is not remote and does require patient interaction.
Requirements
- Completion of a Bachelor’s Degree in social work, psychology, or related field from an accredited college or university 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 of documentation necessary for the pre-certification of admissions and extensions of hospital stays for all patients
- serving as liaison with gatekeepers, HMO’s, OHCA, and insurance companies
- maintaining spreadsheets and logs daily
- auditing of required medical record entries
- assisting with coordination of transfers
- contributing to the quality improvement process
- compliance with JCAHO, Title XIX and other regulatory standards
- participating in interdisciplinary treatment teams, clinical management meetings, agency meetings, and other duties as assigned
Benefits
- Generous base salary with a competitive benefits allowance
- Multiple insurance plan options, no pre-existing condition exclusions
- Healthcare and dependent care FSA options
- 11 paid holidays
- 15 vacation days
- 15 sick days in the first year
- Employer-matched retirement savings plan
- Employee Assistance Program (EAP)
- Bonuses for continued service
- Ongoing training opportunities and CEU support
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
101-250 employees
