Utilization Review Specialist
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
- One year of technical clerical, administrative, secretarial, or general office work
- Valid driver’s license
- Ability to travel as needed for job-related duties
- Must pass pre-employment and pre-placement drug and alcohol screening
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
- Collecting and analyzing 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
- Contributing to quality improvement initiatives
- Ensuring compliance with JCAHO, Title XIX, and other regulatory standards
- Collaborating closely with the Director of Operations, medical, clinical, and reimbursement staff
- Participating in interdisciplinary treatment teams, clinical management meetings, and agency meetings
- Performing other duties as assigned
Benefits
- Annual base salary of $38,500
- Generous benefits allowance
- Comprehensive Health Coverage with no pre-existing condition exclusions
- Flexible Spending Accounts for healthcare and dependent care expenses
- 11 paid holidays
- 15 days of vacation in the first year
- 15 days of sick leave in the first year
- Retirement Savings Plan with a generous company match
- Employee Assistance Program
- Longevity Bonuses
- Training Opportunities for CEU requirements
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
