What are the responsibilities and job description for the Clinical Optimization Specialist position at Harbor Oaks Hospital?
Overview:
Harbor Oaks Hospital, a leading mental health and addiction treatment center in New Baltimore, MI, is seeking a skilled Utilization Review Manager to optimize patient care and reimbursement.
The successful candidate will be responsible for monitoring the utilization of services, securing authorizations with insurance companies, and evaluating compliance with regulations and policies.
Responsibilities:
- Provide consultation and guidance on admissions and patient length of stay to various payers
- Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for the duration of the patient stay
- Evaluate the utilization program for compliance with regulations, policies, and procedures
- Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment
- Manage staff, including hiring, development, training, performance management, and communication to ensure effective department operation
Qualifications:
- Candidates must have current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services
- CPR and de-escalation and restraint certification is required (training available upon hire and offered by the facility)
- First aid may be required based on state or facility requirements
Work Environment:
This is a non-exempt position working Monday through Friday on a day shift, with two days per week. The rate of pay is $25.00-$35.00 per hour, based on experience.
Salary : $25 - $35
