What are the responsibilities and job description for the Utilization Review Specialist - PRN position at Sonora Behavioral Health?
ESSENTIAL FUNCTIONS:
- Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
- Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of 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.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
- This is an on-site position. Non- Remote
- EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Associate's degree required. Bachelor's or master’s degree in social work, behavioral or mental health, Nursing or other related health field preferred.
- Four or more year's clinical experience with the population of the facility and previous experience in utilization management required.
Experience
Preferred- 2 year(s): Behavioral health experience
Skills
Required- Attention to Detail
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
