Utilization Review-Case Management (Full-Time)

Job Description

Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers.

*Pay Range: $32/hr. to $60/hr.

Work Schedule: Monday to Friday from 8:00 a.m. to 4:30 p.m.

Responsibilities:

Admissions: Conduct admission reviews

Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews

Payment Appeals: Prepare and submit appeals to third party payers

Recordkeeping: Maintains appropriate records of the Utilization Review Department

Training: Provide staff in-service training and education

Maintains confidentiality of patients at all times

Ability to cope well with stress and have a strong sense of compassion

Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds

Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint)

Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines

Strong written and verbal communication skills

Strong interpersonal skills. Ability to work with people with a variety of background and educational levels

Ability to work independently and as part of a team

Good judgment, problem solving and decision-making skills

Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others

Ability to work in a fast-paced, expanding organization

Skills:

Demonstrated knowledge of health care service delivery systems and third party reimbursement

Two or more years’ experience working in managed care environment

Ability to apply and interpret admission and continued stay criteria

Strong understanding of admission and discharge function

Familiarity with medical terminology, diagnostic terms and treatment modalities

Knowledge of medical record keeping requirements

Ability to comprehend psychiatric evaluations, consults, and lab results

Requirements

Preferred; Current license as RN, LVN/LPT, LCSW

Preferred; Master’s degree in Social Work, Behavioral Science, or related field

Current BLS Certification for Healthcare Providers

Benefits

401K Retirement Plan

Health Insurance

Vision Insurance

Dental Insurance

Pet Insurance

Healthcare Spending Account & Dependent Care Spending Account

Life Insurance (Supplemental Life, Term, and Universal plans are also available.)

PTO Plan with Holiday Premium Pay

PTO Cash Out option

Sick Pay

Short and Long-Term Disability (with additional buy-in opportunities)

Tuition Reimbursement

Employee Assistance Program

ID Theft Protection

Full-time