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Utilization Review Specialist Location: US-CA-Anaheim Email this job to a friend
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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 Minimum Requirements: Education and Licensing: - Current CA RN
- Masters degree in social work, Behavioral Science, or related field, preferred.
- Current CPR certification.
- CPI, MAB or Behavioral Violence Prevention within 60 days of employment and maintain current.
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 twenty-five (25) pounds.
Benefits - 401(K)
- Continuing Education Credits
- Dental Insurance
- Disability Insurance
- Employee Assistance Program
- Flexible Spending Account
- Health Insurance
- Life Insurance
- Paid Sick Leave
- Paid Time Off (PTO)
- Pet Insurance
- Vision Insurance
Salary: $35.28 - $49.18 per hour
Aliso Ridge Behavioral Health & Anaheim Community Hospital
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