Utilization Review Specialist
About The Position
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. Job Type/Salary: Job Type: Full-time, Non-Exempt Work Schedule: Monday – Friday, 8:00 a.m. – 5:00 p.m. Annual Salary: $38,500 ($18.50 per hour) Posted until filled
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
- 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, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue
- participating in interdisciplinary treatment teams, clinical management meetings, and agency meetings
- performing other duties as assigned
Benefits
- Generous Benefits: Annual base salary of $38,500 plus a generous benefits allowance.
- Comprehensive Health Coverage: A wide choice of health insurance plans with no pre-existing condition exclusions.
- Flexible Spending Accounts: Options for healthcare and dependent care expenses.
- Ample Time Off: 11 paid holidays, 15 days of vacation, and 15 days of sick leave in the first year.
- Retirement Savings Plan: With a generous company match to help secure your future.
- Employee Assistance Program: Support when you need it.
- Longevity Bonuses: For years of dedicated service.
- Training Opportunities: Continuous learning and development for CEU requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
11-50 employees
