Utilization Review Specialist - Supplemental/As Needed - Registered Nurse or Master of Social Work Job at Deaconess Health System
Join our Team
We are looking for compassionate, caring people to join our talented staff of health care professionals as we continue to grow to be the preferred, regional health care partner in our community.
Benefits
We pride ourselves in retaining our top talent by offering work environments that support professional development and personal success. In addition to our robust healthcare and retirement plans, we offer:
- Onsite children’s care centers (Infant through Pre-K) at various locations
- Tuition reimbursement
- Free access to fitness centers, where health coaches are available to help with workout plans at various locations
- Career advancement opportunities
- Competitive pay, shift and weekend incentives, yearly opportunities for pay increases and bonuses
You will play a critical role in continuing the healing mission of Deaconess.
Job Summary
This position is supplemental, as needed.
The Utilization Review Specialist monitors the patient’s benefits, assures reimbursement coverage, and identifies areas of concern. Completes all aspects of patient reviews and collaborates with the multi-disciplinary treatment team members to assure the patient’s treatment and follow-up care is as seamless as possible. Promotes quality cost-effective outcomes and optimizes reimbursement for organizational services. Prepares detailed service delivery reports regarding activity, volume, and utilization. Consistently exemplifies the Deaconess Cross Pointe standards to both internal and external organizational customers across the health care continuum.
- Conducts reviews, maintains work queries within established time frames, and enters clear authorization documentation tracking to avoid technical reimbursement denials.
- Maintains, updates, and communicates knowledge of levels of care criteria, clinical necessity documentation, third-party reimbursement requirements, and confidentiality guidelines for behavioral health care.
- Actively participates in treatment planning to establish goals that meet patient’s needs.
- Establishes and maintains positive relationships with multi-disciplinary treatment providers.
- Proactively identifies cases with risk of complications in service delivery, follow-up, or reimbursement issues. Facilitates issue resolution with treatment team.
- Researches, develops, updates and maintains accurate reports and records of services, assessments, diagnosis, providers, admissions, census, authorizations, concurrent reviews, denials, and follow-up.
- Facilitates communication and updates physicians on third-party payer requirements and phone reviews.
- Collaborates with manager to research and resolve barriers in the reimbursement process.
Education and Experience
Graduate of an accredited RN, social work or related program.
Experience in psychiatric setting is preferred.
Prior experience in case management preferred.
Certificates, Licenses, Registrations
Current RN, LCSW, MSW, LMFT or LMHC
Location: Deaconess Cross Pointe · Outpatient
Schedule: Supplemental, Day
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