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.
- Equivalent combination of education and experience is accepted.
- Valid driver’s license
- 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
- Prepare documentation for pre-certification of admissions and continued stays.
- Serve as a liaison with gatekeepers, HMOs, OHCA, and insurance providers.
- Maintain daily logs and tracking spreadsheets.
- Collect and analyze 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.
- Coordinate patient transfers when appropriate.
- Contribute to quality improvement initiatives.
- Ensure compliance with JCAHO, Title XIX, and other regulatory standards.
- Collaborate closely with the Director of Operations, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue.
- Participate in interdisciplinary treatment teams, clinical management meetings, and agency meetings.
- Perform other duties as assigned.
Benefits
- Annual base salary of $38,500
- Generous benefits allowance
- A wide choice of health insurance plans with no pre-existing condition exclusions
- Flexible Spending Accounts for healthcare and dependent care expenses
- 11 paid holidays
- 15 days of vacation
- 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
