Utilization Review Specialist

Bluestone Child & Adolescent Psychiatric Hospital • University Heights, OH

3d • Onsite

About The Position

Bluestone Child & Adolescent Hospital is seeking dynamic healthcare professionals interested in bringing psychiatric care to a new level for children ages 6-17. Working in a brand new, 12 bed state-of-the-art facility, Bluestone staff will have a unique ability to direct patient care, employ best practices, and join a care network that promotes the best long-term outcomes for patients.

Requirements

• Associates Degree in Nursing, Social Work, Mental Health/Behavioral Sciences required.
• LPN, RN, LSW, LPC, MFT, LISW, LPCC or LMFT required.
• Sensitivity in relating to persons of varying backgrounds and demonstrated ability to work with diverse groups of people possessing various strengths, aptitudes and abilities.
• Ability to perform job responsibilities with a high degree of initiative and independent judgment.
• Demonstrated oral and written communication skills and effective interpersonal skills.
• Proficiency in using Agency computer systems and software as required to perform essential job functions.
• Practical and creative problem solving skills.

Nice To Haves

• Bachelor’s or Master’s Degree in related field preferred.
• 3-5 years related experience preferred.
• 1-2 years-experience in behavioral health utilization review preferred.

Responsibilities

• Complete initial, concurrent, and retrospective reviews of patient care in a timely manner to ensure continuous coverage for patients in inpatient treatment.
• Initiate, schedule, and meaningfully participate in peer reviews and expedited appeals between third-party payers and facilities as needed.
• Maintain sophisticated and current knowledge of mental health disorders including DSM-V knowledge, ICD-10 diagnoses and treatment processes.
• Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners including the admitting psychiatrist.
• Collaborate with treatment team to discuss clinical authorization and quality of care.
• Consistent and timely response to emails and other communications relating to utilization review.
• Prepare and submit appeals utilizing their independent knowledge and expertise.
• Familiarity with processing correspondence with adherence to HIPPA guidelines.
• Assist with the Intake process for Bluestone admissions, including answering phone calls and reviewing faxed or emailed referrals.
• Complete all data tracking as needed.
• As relevant to scope of practice, complete psychosocial assessments or group treatment services for either inpatient or outpatient admissions.

Benefits

• Competitive benefit options to our employees and their families, including domestic partners.
• Comprehensive health and Rx plans, including a flat rate option.
• Wellness program including free preventative care
• Generous paid time off and holidays
• 50% tuition reduction at Case Western Reserve University for the MSW program
• 403(b) retirement plan with an employer match
• Pet insurance
• Employer paid life insurance and long-term disability
• Employee Assistance Program
• Support for continuing education and credential renewal
• Ancillary benefits including: dental, vision, voluntary life, short term disability, hospital indemnity, accident, critical illness
• Flexible Spending Account for Health and Dependent Care

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree