Utilization Review Specialist

Overview

New Acute Psychiatric Hospital serving the desert communities is seeking an experienced individual to proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential.

The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility.

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

• Required
  
  Education:
  
  High school diploma or equivalent.
• Preferred Education:
  
  Associate's, Bachelor s, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Experience:
  
  Clinical experience is required, or two or more years  experience working with the facility s population. Previous experience in utilization management is preferred
• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I

Job Type: Full-time

Pay: $32.00 - $36.00 per hour

Expected hours: 40 per week

• Annual accrual of vacation, sick, and extended sick time in accordance with Indio Behavioral Health, LLC accrual policies.
• Group health insurance, 401(k), and other benefits in accordance with Indio Behavioral Health, LLC benefit plans.
• Annual performance evaluation and salary review.
• Professional development assistance
• Tuition reimbursement

Equal Opportunity Employer

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