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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

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