Coordinator - Utilization Review - CMC Utilization Management - Full Time - 8 Hour - Days

Coordinator - Utilization Review - CMC Utilization Management - Full Time - 8 Hour - Days page is loaded## Coordinator - Utilization Review - CMC Utilization Management - Full Time - 8 Hour - Dayslocations : Concordtime type : Full timeposted on : Posted Todayjob requisition id : JR0016547## Job Description : Coordinates utilization review activities to ensure clinical documentation is accurate to secure mental health and addiction treatment authorizations for patients from their government or commercial health plans. This position is the primary liaison between Medical Staff, Treatment Team, and government or commercial health plans that authorize and reimburse treatment. Reviews clinical documentation, treatment plans, and monitors care delivery within the medical record, ensuring patients receive necessary treatment at the appropriate level of care based on the clinical documentation. Collaborates and partners closely with the Manager of Business Operations and their team to secure authorizations for treatment and address denials of care. Initiates appeal process and monitors response. Communicates utilization review and reimbursement issues, trends and patterns to the Manager of Medical Staff and Clinical Effectiveness. Education :

• Graduate of Psychiatric Technician Program Experience :
• 1-year Behavioral Health Experience strongly - Preferred
• 1-year EPIC experience strongly - Preferred Additional Experience :
• 1-year Utilization Review Experience strongly - Preferred Licenses / Certification :
• Psychiatric Technician - California Board of Vocational Nursing and Psychiatric Technicians
• BLS Basic Life Support - American Heart Association Skills - Core :
• Good Communication, documentation and organizational skills.
• Self-motivation and independent decision-making skill.
• Demonstrates personal maturity, independent judgement and integrity.Days worked per week : Monday - Friday## Work Shift : 08.0 - 08 : 00 - 16 : 30 No Waive (United States of America) Pay Range : $40.35 - $54.46### ### Hourly### Offer amounts are based on demonstrated / relevant experience and / or licensure.Pay will be adjusted to the local market if hired outside of the Bay Area.Note : Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word 'exempt' on it.## Scheduled Weekly Hours : 40 John Muir Health is a nationally recognized, not-for-profit health care organization east of San Francisco serving patients in Contra Costa, Alameda and southern Solano Counties. It includes a network of more than 1,000 primary care and specialty physicians and 6,300 employees, The health system's facilities include John Muir Health, Walnut Creek Medical Center (554-bed acute care facility), which serves as Contra Costa County's only designated trauma center, and John Muir Health, Concord Medical Center (247-bed acute care facility). Together, they are recognized as top centers for neurosciences, orthopedic, cancer, cardiovascular, trauma, emergency, pediatric, and high-risk obstetrics care. Other areas of specialty include general surgery, robotic surgery, weight-loss surgery, rehabilitation and critical care. In February 2024, John Muir Health opened the Behring Pavilion, which is home to the UCSF-John Muir Health Jean and Ken Hofmann Cancer Center in Walnut Creek. This state-of-the-art facility brings cancer prevention, diagnosis, treatment, and care coordination into one location. Patients benefit from the expertise of top cancer specialists from John Muir Health and UCSF Health and have access to the latest treatment advances close to home. John Muir Health also offers complete inpatient and outpatient behavioral health programs and services at our 73-bed fully accredited psychiatric hospital and outpatient center located in Concord. In addition, John Muir Health provides a number of primary care and outpatient services at 89 practice sites throughout the community and urgent care centers in Berkeley, Brentwood, Concord, San Ramon and Walnut Creek. John Muir Health offers a collaborative, patient-centered health care environment with an emphasis on listening, explaining, and working together as a team, to help patients achieve their optimal health. We recognize those who exemplify excellence and reward them for contributing to our collective success. From individual to department to spontaneous recognition, Employee of the Month, Employee Suggestion Program rewards, Employee Success Sharing Program, and many more, we find unique ways to thank our employees for the outstanding efforts they make every day. Competitive salary and benefit package available. At John Muir Health, we strive to be a leading health system through the cultivation of a culture of belonging where every patient, employee, provider, and community member feels safe and valued for embracing all aspects of their differences. As an Equal Opportunity employer, we encourage and consider all applicants for employment without regard to race, religion, national origin, gender, sexual orientation, gender identity, gender expression, age, veteran status, disability, or any other characteristic protected by law. For more information, please visit the EEO website . All hospitals are accredited by The Joint Commission, a national surveyor of quality patient care. John Muir Health is an equal opportunity employer.

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