What are the responsibilities and job description for the Utilization Review Clinician position at Generations Behavioral Health - Geneva?
Generations Behavioral Health an Equal Opportunity Employer is seeking a Utilization Review Clinician for its 56-bed hospital in Geneva Ohio.
Generations Behavioral Health – Geneva is dedicated to providing services to adults and their families who are experiencing problems related to mental illness with the best trained and motivated professionals resulting in exceptional outcomes. Our commitment to compassion and integrity is an integral part of our plan of care.
Utilization Review Clinician - Inpatient Psychiatric Hospital
Job Summary:
The Utilization Review (UR) Clinician is responsible for evaluating the clinical necessity, appropriateness, and efficiency of healthcare services provided to patients in an inpatient psychiatric setting as compared to medical necessity criteria. This role involves conducting clinical reviews, ensuring compliance with regulatory and reimbursement requirements, and collaborating with healthcare providers to optimize patient care and resource utilization. This role is crucial in ensuring that patients receive the right care at the right time while managing the hospital's resources efficiently.
Key Responsibilities:
- Clinical Review and Assessment:
- Perform concurrent and retrospective reviews of clinical records to determine the medical necessity of admissions, continued stays, and services provided.
- Evaluate treatment plans related to mental health and substance abuse to ensure they meet established guidelines and criteria.
- Conduct prior authorization reviews to determine the medical appropriateness of services.
- Complete first level appeal options as needed to ensure continued stay.
- Compliance and Documentation:
- Maintain up-to-date knowledge of federal, state, and local regulations, as well as payer requirements related to utilization management as provided by the utilization review manager.
- Ensure accurate and timely documentation of all utilization review activities.
- Interdisciplinary Collaboration:
- Work closely with physicians, nurses, social workers, and other healthcare professionals to ensuring compliance with regulatory and reimbursement requirements.
- Quality Improvement:
- Participate in quality improvement initiatives and projects as requested.
Qualifications:
- Education: Bachelor's degree in Nursing, Social Work, or a related field.
- Licensure: Current licensure as a Registered Nurse (RN), Licensed Practical Nurse (LPN) Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), or equivalent.
- Experience: Minimum of 2-4 years of experience in utilization review, case management, or a related field preferred, preferably in a psychiatric setting.
- Skills:
- Strong analytical and critical thinking skills.
- Excellent communication and interpersonal skills.
- Ability to work independently and as part of a team.
Work Environment:
- The UR Clinician works onsite in an office setting within the hospital.
- The position involves regular interaction with coworkers, healthcare providers, and insurance representatives.
Job Type: Full-time
Pay: From $25.00 per hour
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: In person
Salary : $25
