Behavioral Health Utilization Reviewer

Position Summary

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.

Posted Salary Range

USD $26.00 - USD $34.00 / Hr.

Duties & Responsibilities

• 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

Qualifications & Requirements

Benefits

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

EOE Statement

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