Utilization Review Specialist

Job Summary: Performs utilization review with external agencies to ensure payment for medically necessary inpatient services. Essential Functions: Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives. Performs ongoing review of charts for inpatient psychiatric patients and partial hospitalization patients based on approved utilization review criteria. Refers utilization review issues to physician advisor and treatment team as appropriate. Appeals denied psychiatric days according to approved procedures. Maintains up-to-date information regarding requirements of individual insurance companies, and ensures these requirements are met. Participates in hospital utilization review committees as appropriate to psychiatric utilization review duties. Documents all communications and updates accordingly. Maintains stats regarding denied/uncovered days and length of stay. Delivers and tracks the Important Message from Medicare form. Acts as the court liaison. Assists as needed with phone intakes. Minimum Qualifications: Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review. Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification. Knowledge, Skills & Abilities: Master’s degree in Psychology, preferred. Previous experience with utilization review, case management or telephone triage desired. Familiarity with electronic medical records and medical terminology. Working Conditions: Potential exposure to infectious disease. Physical Requirements: Constantly sit, see/visual acuity, handle/grasp/feel, talk/hear, lift/carry 1 to 25 lbs. Frequently stand, walk, reach, bend/twist, lift/carry 25 to 49 lbs. Occasionally lift/carry 50+ lbs. Marshall, 200 N. Madison, Marshall, MI 49068 #J-18808-Ljbffr