Harboroaks
Overview
Salary Range: LMFT/LPCC/LCSW $33.00 - $50.00 per hour - Based on Experience
Salary Range: LVN $33.00 - $43.75 per hour - Based on Experience
Salary Range: RN: $60.00 - per hour - Based on Experience
Location: ONSITE ONLY
San Jose Behavioral Health is currently seeking a
Utilization Review Specialist - Full Time
to assist the Utilization Department staff with comprehensive inpatient care and treatment within our 133-bed Acute Psychiatric Hospital. Our facility provides adults and adolescents comprehensive inpatient treatment for a range of behavioral and mental health disorders, conveniently located in the heart of San Jose and easily accessible to residents in Santa Clara, San Mateo, and Alameda Counties.
San Jose Behavioral Health
provides a comprehensive package of benefits for full-time employees, including:
Competitive salary, Medical, dental, and vision insurance, Acadia Healthcare 401(k) plan with match, General Paid Time off (Vacation, Sick, Personal Days, Extended Sick Leave, and Holidays), Excellent training program, and Professional growth opportunities within a national family of hospitals and facilities.
PURPOSE STATEMENT:
The
Utilization Review Specialist
coordinates and assesses the inpatient census for appropriate alternate health care service needs. Responsibilities include performing onsite and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines. The specialist also coordinates with discharge planning processes, provides feedback on documentation processes, and serves as a resource to the clinical team regarding approved criteria, practice guidelines, and alternative treatment options.
Responsibilities
Act as liaison between managed care organizations and the facility’s professional clinical staff.
Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and coordinate communication concerning reimbursement requirements.
Monitor patient length of stay and extensions, informing clinical and medical staff of potential impact on length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges, and quality of services as requested by facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between the facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria, and medical necessity updates.
Perform other functions and tasks as assigned.
Qualifications
Associate Degree in Nursing (LPN/LVN/RN) Required.
Bachelors or Masters degree in Social Work, Behavioral Health, Mental Health, Nursing, or another related health field preferred.
Two or more years of experience with the population served in our facility preferred.
Previous experience in utilization management preferred.
Licenses, Designations, Certifications
Licensed LMFT, LMSW, LCSW, LPC, or LPC-I in the state where the facility provides services, or equivalent clinical professional license or certification.
CPR, de-escalation, and restraint certification required (training available upon hire).
Additional Regulatory Requirements While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g., emergencies, changes in workload, rush jobs, or technological developments) dictate.
Equal Opportunity Statement We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
Compensation Compensation for roles at San Jose Behavioral Health varies depending on a wide array of factors, including but not limited to location, role, skill set, and level of experience. As required by local law, the facility provides a reasonable hourly range of compensation:
LMFT/LPCC/LCSW $33.00 - $50.00 per hour, LVN $33.00 - $43.75 per hour, RN $60.00 per hour.
Position is onsite only.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
#J-18808-Ljbffr
Salary Range: LVN $33.00 - $43.75 per hour - Based on Experience
Salary Range: RN: $60.00 - per hour - Based on Experience
Location: ONSITE ONLY
San Jose Behavioral Health is currently seeking a
Utilization Review Specialist - Full Time
to assist the Utilization Department staff with comprehensive inpatient care and treatment within our 133-bed Acute Psychiatric Hospital. Our facility provides adults and adolescents comprehensive inpatient treatment for a range of behavioral and mental health disorders, conveniently located in the heart of San Jose and easily accessible to residents in Santa Clara, San Mateo, and Alameda Counties.
San Jose Behavioral Health
provides a comprehensive package of benefits for full-time employees, including:
Competitive salary, Medical, dental, and vision insurance, Acadia Healthcare 401(k) plan with match, General Paid Time off (Vacation, Sick, Personal Days, Extended Sick Leave, and Holidays), Excellent training program, and Professional growth opportunities within a national family of hospitals and facilities.
PURPOSE STATEMENT:
The
Utilization Review Specialist
coordinates and assesses the inpatient census for appropriate alternate health care service needs. Responsibilities include performing onsite and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines. The specialist also coordinates with discharge planning processes, provides feedback on documentation processes, and serves as a resource to the clinical team regarding approved criteria, practice guidelines, and alternative treatment options.
Responsibilities
Act as liaison between managed care organizations and the facility’s professional clinical staff.
Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and coordinate communication concerning reimbursement requirements.
Monitor patient length of stay and extensions, informing clinical and medical staff of potential impact on length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges, and quality of services as requested by facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between the facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria, and medical necessity updates.
Perform other functions and tasks as assigned.
Qualifications
Associate Degree in Nursing (LPN/LVN/RN) Required.
Bachelors or Masters degree in Social Work, Behavioral Health, Mental Health, Nursing, or another related health field preferred.
Two or more years of experience with the population served in our facility preferred.
Previous experience in utilization management preferred.
Licenses, Designations, Certifications
Licensed LMFT, LMSW, LCSW, LPC, or LPC-I in the state where the facility provides services, or equivalent clinical professional license or certification.
CPR, de-escalation, and restraint certification required (training available upon hire).
Additional Regulatory Requirements While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g., emergencies, changes in workload, rush jobs, or technological developments) dictate.
Equal Opportunity Statement We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
Compensation Compensation for roles at San Jose Behavioral Health varies depending on a wide array of factors, including but not limited to location, role, skill set, and level of experience. As required by local law, the facility provides a reasonable hourly range of compensation:
LMFT/LPCC/LCSW $33.00 - $50.00 per hour, LVN $33.00 - $43.75 per hour, RN $60.00 per hour.
Position is onsite only.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
#J-18808-Ljbffr