Utilization Review Clinician

Utilization Review Clinician

Job Code: BH1400

ABOUT US

We are welcoming a new era in healthcare where achieving good health is just the beginning. At UVA Health Northern VA & Culpeper, we believe in caring for the whole person by getting to know - and making connections with - our patients. By combining the talent and expertise of our people, the breadth of capabilities across our system, and our commitment to helping our communities get better and stay healthy, we are improving the patient experience.

As a UVA Health Northern VA & Culpeper team member, you will have a voice in patient care decisions, support the most advanced medical technologies and feel a strong sense of satisfaction from making a difference in people's lives every day.

JOB TYPE

Classification: Nonexempt

Supervises Positions: No

JOB SUMMARY

The Utilization Review Clinician serves as a leader resource in the Utilization Review process. They collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance. The UR clinician coordinates and conducts initial, concurrent, and retrospective medical necessity reviews. All Utilization Review activities are performed in accordance with the current policies and procedures, mission, vision, and values of UVA Health Northern VA & Culpeper.

Human Experience: Provides guidance to team members as they navigate patient concerns through teaching, good communication, and trust building behaviors.

Utilizes relationship building skills through rounding to provide training and coaching to team members on how to effectively connect with patients.

Uses patient feedback to create innovative ideas to meet patient needs.

Ensures team members have pertinent information to educate patients on procedures and processes.

Teamwork: Develops and maintains positive relationships with team members, leadership, and community providers.

Demonstrates a willingness to adjust activities to accommodate the needs of team members.

Develops team members through mentoring, precepting, orientation, and timely feedback.

Collaborates with leaders and other team members for positive experiences for patients.

Behavioral Health Expertise: Has a deep knowledge of psychiatric medications, psychiatric diagnosis, mental health concepts, and evidence based therapeutic interventions and treatments.

Implements treatment plan using best practice modalities and interventions to obtain optimal patient outcomes.

Establishes and maintains control of violent patients, defends self and others against violent assaults, and reacts appropriately during a psychiatric crisis.

Continues professional development and assumes responsibility as a self-directed professional for continuing education.

Communication: Consistently utilizes professional communication within the interdisciplinary team and when handing off patient care.

Communicates individualized plan of care and patient's progress toward goals to all members of the care team including the patient and his/her chosen support system/legal guardian.

Complies with required standards for medical/legal reporting and documentation situations.

Accepts responsibility for actions and responds positively to feedback.

The incumbent may be asked to perform additional duties as assigned.

QUALIFICATIONS

Education: Graduate of an accredited School of Nursing required. If your RN nursing license has been inactive, retired or lapsed for five years or more and you have not been licensed in another state during the last five years, successful completion of a Board approved refresher course is required prior to reactivating or reinstating your license. In order to be considered for current licensure status, you must apply for reinstatement within one year of completing the refresher course - or - Master's Degree in Social Work. 4 Year/Bachelor's Degree preferred.

Experience: Minimum of 2 years of Behavioral Healthcare experience and Utilization Review or related experience preferred. Refer to the Life Support Training Policy for additional details.

Licensure: Current RN or LCSW/LPC licensure in applicable state required.

Additional Skills/Requirements Required: Good working knowledge of computers. Knowledge of Behavioral Health age specific populations.

Additional Skills/Requirements Preferred: N/A

PHYSICAL DEMANDS

Physical Demand Code: 18A, Mental Health Associate

Work Function/Activity: Medium to Heavy Physical Demand

The job requires constant sitting, standing, walking, and bending/stooping. Frequent repetitive body movements. Proficient communicative, auditory, and visual skills. Attention to detail and ability to write legibly. Ability to lift/push/pull up to 100 lbs. occasionally. For any weight over 35 lbs. use Safe Handling Equipment. This job description may not include all assigned duties, responsibilities, or aspects of the job described. It may be amended at any time at the sole discretion of UVA Health Northern VA & Culpeper.

OTHER

May require the use of safety equipment, such as HEPA mask, for infection prevention: Yes

On call responsibilities as directed: Yes

Ability to travel between campus buildings, remote facilities, and out of town as needed: Yes