Utilization Review Specialist-day shift position - Requisition

Job Summary: Performs utilization review with external agencies to ensure payment for medically necessary inpatient services.

Essential Functions:

• Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives.
• Performs ongoing review of charts for inpatient psychiatric patients and partial hospitalization patients based on approved utilization review criteria.
• Refers utilization review issues to physician advisor and treatment team as appropriate.
• Appeals denied psychiatric days according to approved procedures.
• Maintains up-to-date information regarding requirements of individual insurance companies, and ensures these requirements are met.
• Participates in hospital utilization review committees as appropriate to psychiatric utilization review duties.
• Documents all communications and updates accordingly.
• Maintains stats regarding denied/uncovered days and length of stay.
• Delivers and tracks the Important Message from Medicare form.
• Acts as the court liaison.
• Assists as needed with phone intakes.

Minimum Qualifications: Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review. Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification.

Knowledge, Skills & Abilities: Master’s degree in Psychology, preferred. Previous experience with utilization review, case management or telephone triage desired. Familiarity with electronic medical records and medical terminology.

Working Conditions: Potential exposure to infectious disease.

Physical Requirements: Constantly sit, see/visual acuity, handle/grasp/feel, talk/hear, lift/carry 1 to 25 lbs. Frequently stand, walk, reach, bend/twist, lift/carry 25 to 49 lbs. Occasionally lift/carry 50+ lbs.

Marshall, 200 N. Madison, Marshall, MI 49068