Utilization Specialist

Company: Aliso Ridge Behavioral Health & Anaheim Community
Location: Aliso Viejo
Posted on: May 26, 2023

Job Description:

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.
• 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. Minimum Requirements: Education and Licensing:
  • Current license as RN, LVN/LPT, LCSW,
  • Preferred; Master's degree in Social Work, Behavioral Science, or related field.
  • Current CPR certification.
  • Crisis Prevention Intervention (CPI) (or equivalent as approved by CNO) obtained within 60 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: Requirements 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
        • Medical, Dental and Vision
        • Voluntary Benefits
        • Health Saving
        • PTO Salary: $20.89 - $29.13 per hour

Keywords: Aliso Ridge Behavioral Health & Anaheim Community , Aliso Viejo , Utilization Specialist, Other , Aliso Viejo, California