About Job

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.

Minimum Requirements:

Education and Licensing:

· Current license as RN, LVN/LPT, or relevant Clinician, preferred.

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

· Current CPR certification recommended.

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.

Job Type: Full-time

Pay: $20.89 - $29.13 per hour

Benefits: