Utilization Review Analyst - Perinatal Mental Health Unit

The Utilization Review Analyst analyzes patient records daily to determine the appropriateness of admission, level of care, continued stay and discharge specifically for an inpatient behavioral health unit. Abstracts variances to standard pathway process. Provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. Exercises concurrent review techniques utilizing evidence based guidelines such as Interqual and Milliman to communicate with multidisciplinary personnel and insurance providers; Enhances the quality of patient management and satisfaction while promoting continuity of care and cost effectiveness through integration of utilization management, case management and discharge planning. Performs various duties assigned by department management according to policies and procedures and the mission of Woman's Hospital.

Requirements:

• Graduate of an accredited school of nursing; currently licensed to practice professional nursing in the State of Louisiana.
• BSN strongly preferred.
• Must have a minimum of two years' prior experience in a clinical setting, such as Antepartum, Obstetrical, Post Partal, NICU and/or Med- Surg.
• 2 years Behavioral Health experience preferred.
• 3-5 years' experience in Case Management/Utilization Review preferred.

Responsibilities:

• Oversees the intake process of all admissions onto the Perinatal Mental Health Unit, including all appropriate documentation and forms.
• Conducts initial screenings and assessments to determine the needs of patients seeking behavioral health services.
• Performs admission screening within 24 hours of admit for inpatient and outpatient based on criteria and standards approved by the medical staff in accordance with applicable accreditation, regulatory, and third party payor requirements.
• Provides data to managed care companies on patients for initial and continued stay necessity within 24 hours of receipt of call. Initiates calls, as required to assure certification or authorization of continued stay.
• Performs periodic medical record review using review table for elements of medical record standards
• Accounts for all discharged patients and verifies that status is correct and certification is completed.
• Evaluates the medical necessity for continued hospital services, where appropriate and makes recommendations

Schedule:

Full-Time; On-site

Monday - Friday

8:00 AM - 4:30 PM

Pay Range:

Hourly; Non-Exempt position

$30.49 - $48.00

A Work Experience with Purpose

Woman’s is one of the largest specialty hospitals for women and infants in the United States. We are recognized throughout the country for our innovative programs, and we pride ourselves in surpassing the expectations of those we serve. Providing exceptional patient care and creating exceptional patient experiences are at the center of what we do at Woman’s. Our team consistently exceeds state and national benchmarks for patient satisfaction.

Our employees, organizational culture, mission, vision, values, and benefits make Woman’s a best place to work. In fact, for the 17th year in a row, Woman’s has been recognized as a Best Place to Work by Modern Healthcare – making us the only healthcare organization to earn the distinction every year since the program’s inception. We are proud of the level of care our staff provides to our patients and each other.

If you have any questions or would like to connect with one of our recruiters directly, please e-mail hrjobs@womans.org

Woman’s Hospital is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law.