UR Specialist

Overview

Coachella Valley Behavioral Health in Indio, California, provides specialized inpatient mental health services for adults aged 18 and older. Our multidisciplinary team, including experienced psychiatrists, psychologists, nurses, and therapists, offers personalized care to address a range of mental health concerns such as PTSD, anxiety, depression, and bipolar disorder. With a focus on 24/7 support, we ensure that every individual receives comprehensive, customized therapy to foster recovery and long-term well-being.

We are committed to creating a supportive environment to facilitate the healing journey of our patients.

THIS IS AN ON-SITE POSITION - NOT REMOTE

• 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
• Benefits:
  • Employee assistance program
  • Paid time off
  • Professional development assistance
  • Retirement plan
• Experience:
  • Utilization Management: 1 year (Required)
• Ability to Commute:
  • Indio, CA 92201 (Required)
• Work Location:
  
  In person