Behavioral Health Utilization Reviewer

Are you a detail-oriented and results-driven healthcare professional with a passion for ensuring the highest quality of patient care?

We are seeking a dedicated Utilization Reviewer to join our team! As the Utilization Reviewer, you will play a critical role in establishing and maintaining efficient methods of ensuring the medical necessity and appropriateness of hospital admissions while performing concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient’s medical records.

If you are a highly organized and analytical professional with a strong commitment to quality and efficiency, we encourage you to apply.

• Maintains significant contact with referring healthcare professional associations, nursing service personnel, medical staff, patients, families, insurance representatives, and other staff.
• Performs insurance verification and ongoing concurrent reviews. Assists hospital business office with matters related to insurance reimbursement
• Completes cost/benefit analysis of treatment plans.
• Coordinates and communicates with all clinical professionals involved with patients.
• Conducts himself/herself in a professional manner in compliance with unit and hospital policies.
• Assists the billing department in appealing denials through the payer's appeal process.
• Understands the language of contracts. Determines alternative care options, performs cost-benefit analyses, and develops a treatment plan that effectively addresses the patient's needs.
• Monitors the patient’s clinical progress as well as that of the treatment plan.
• Works with the marketing team on inquiries and/or referrals, as requested.
• Collaborates with the attending physician and treatment team to facilitate patient conferences which develop, monitor and refine the treatment plan to achieve identified patient outcomes.
• Facilitates effective team communication regarding new patients' special needs and preliminary disposition plans.
• Maintains daily contact with nursing and social services staff to identify patient needs related to diagnosis, treatment, prognosis, and projected date of discharge.
• Works with physician and treatment team to review orders regarding consults, DME, and discharge plans to ensure compliance with the patient’s insurance company.
• Maintains internal tracking documents and spreadsheets on a daily basis and/or s instructed

• Associate’s or Bachelor’s degree in nursing required. 
• 3-5 years of post-licensure experience in a combination of Behavioral Health or Case Management.    
• Must have a current license to practice profession in state. (RN, LPN). Must be certified in CPR
• Must have a reliable source of transportation.  
• Must have a valid driver’s license and automobile insurance
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Proficient with Microsoft Office Suite or related software.
• Ability to effectively utilize electronic medical records software.
• Ability to maintain confidentiality. Reliable transportation required

All of our employees are valued and receive a competitive wage; full time team members are also offered a comprehensive benefit package which includes: 

• Medical, Dental, Vision, Life and Disability Insurance/ Flexible Spending Accounts
• Tuition Reimbursement & Nursing Loan Repayment Programs
• PerkSpot - Local Deals and Weekly Perks Program
• 401(k)
• Paid Time Off Plan
• New Pet Insurance Discount available
• DailyPay option available! – Get your pay, when you need it.
• Purchasing Power - online purchase/payroll deduction
• Tickets at Work - entertainment ticket discounts
• Employee Assistance Plan - easy-to-use services to help with everyday challenges of life (available for all employees and their families) 
• Helping Friends Foundation - our employees’ hardship/crisis fund
• Auto and Home Insurance - employee discount available – payroll deduction!
• In-facility education programs and more!

Drug Free, Smoke-Free work place. Equal Opportunity Employer, including disability/vets