Utilization Review Clinician (Non-Remote) (Santa Rosa)

POSITION TITLE: Utilization Review Clinician

REPORTS TO (TITLE): Director of Utilization Review

DESCRIPTION OF POSITION:

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.

KEY 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.

Requirements

Education/Licensure

• Current license as an LCSW, ASW, MFT, LMFT, RN, LPT, LVN or LPC
• Preferred; Master’s degree in Social Work, Behavioral Science, or related field.
• Current CPR certification.
• Current NCI equivalent as approved by the Chief Nursing Officer (or obtained within the first 30 days of hire).

Knowledge and Experience:

• 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

Skills and Abilities:

• 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.

Physical Requirements:

While performing the duties of this job, this position is frequently required to do the following:

• Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
• Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information.
• Vision: see details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side.
• Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
• Lift up to five (5) pounds.

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Benefits

• Medical
• Vision
• Dental
• 401(k)
• 3.5 Weeks Paid Time Off
• $25,000 Life insurance policy is provided at no charge to the employee