Utilization Review Specialist
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 documentation for pre-certification of admissions and extensions of hospital stays.
- Serving as liaison with gatekeepers, HMO's, OHCA, and insurance companies.
- Maintaining spreadsheets and logs daily.
- Auditing of required medical record entries.
- Data collection and analysis of inappropriate admissions, delays in services/discharges, premature discharges, effectiveness of discharge planning, and over/under utilization of resources.
- Assisting with coordination of transfers when appropriate.
- Contributing to the quality improvement process.
- Ensuring compliance with JCAHO, Title XIX, and other regulatory standards.
- Working closely with the Director of Operations and the medical, clinical, and reimbursement staff to reduce potential loss of collections.
- Participating in interdisciplinary treatment teams, clinical management meetings, and agency meetings.
- Other duties as assigned.
Benefits
- Comprehensive Benefits: Generous base salary with a competitive benefits allowance
- Health Coverage: Multiple insurance plan options, no pre-existing condition exclusions
- Flexible Spending: Healthcare and dependent care FSA options
- Time Off: 11 paid holidays 15 vacation days 15 sick days in the first year
- Retirement Planning: Employer-matched retirement savings plan
- Employee Support: Employee Assistance Program (EAP)
- Longevity Pay: Bonuses for continued service
- Professional Growth: Ongoing training opportunities and CEU support
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Administration of Human Resource Programs
Number of Employees
251-500 employees
