Utilization Review Specialist

Utilization Review Specialist

The Utilization Review (UR) Specialist supports the facility's utilization management processes. Responsibilities include preparing documentation for pre-certification of admissions and continued stays, serving as a liaison with gatekeepers, HMOs, OHCA, and insurance providers, and maintaining daily logs and tracking spreadsheets. The UR Specialist collects and analyzes data related to medical record documentation compliance, inappropriate admissions, delays in services and discharges, premature discharges, effectiveness of discharge planning, and the over- or under-utilization of resources. The role may also involve coordinating patient transfers when appropriate. In addition, this position contributes to quality improvement initiatives and ensures compliance with JCAHO, Title XIX, and other regulatory standards. The UR Specialist collaborates closely with the Director of Operations, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue. The UR Specialist participates in interdisciplinary treatment teams, clinical management meetings, and agency meetings, and performs other duties as assigned. This is an on-site position that requires direct patient interaction.

Job Type/Salary:

• Job Type: Full-time, Non-Exempt
• Work Schedule: Monday – Friday, 8:00 a.m. – 5:00 p.m.
• Annual Salary: $38,500 ($18.50 per hour)

Minimum Qualifications and Experience:

• Bachelor's Degree in social work, psychology, or related field plus one year of technical clerical, administrative, secretarial, or general office work.
• Equivalent combination of education and experience is accepted.
• Preferred: Experience in a mental health setting.

Special Requirements:

• Valid driver's license and the ability to travel as needed for job-related duties.
• Must pass pre-employment and pre-placement drug and alcohol screening due to the safety-sensitive nature of this position.

Why Join Us?

• Generous Benefits: Annual base salary of $38,500 plus a generous benefits allowance.
• Comprehensive Health Coverage: A wide choice of health insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts: Options for healthcare and dependent care expenses.
• Ample Time Off: 11 paid holidays, 15 days of vacation, and 15 days of sick leave in the first year.
• Retirement Savings Plan: With a generous company match to help secure your future.
• Employee Assistance Program: Support when you need it.
• Longevity Bonuses: For years of dedicated service.
• Training Opportunities: Continuous learning and development for CEU requirements.

About us: Griffin Memorial Hospital (GMH) is located in Norman, Oklahoma, and serves all 77 counties in Oklahoma as a Department of Mental Health and Substance Abuse Services (ODMHSAS) treatment center for adults. Griffin Memorial Hospital is a 120-bed acute psychiatric hospital serving persons aged 18 and over with severe mental illness and provides in-patient hospital care for those in need of mental health & substance abuse services. Drug and Alcohol Pre-employment and Preplacement Testing: Upon a conditional offer of employment, applicants for safety sensitive positions shall be required to submit to urinalysis to test for drugs. Appointment to a safety sensitive position shall be contingent upon a negative drug test result. THIS AGENCY REQUIRES COVERAGE 24 HOURS, 7 DAYS PER WEEK. WORK HOURS AND LOCATION MAY VARY DEPENDING ON BUSINESS NECESSITY. EMPLOYEES MAY BE REQUIRED TO WORK WEEKENDS AND OVERTIME. Reasonable accommodation to individuals with disabilities may be provided upon request. An Equal Opportunity Employer.