Sacramento Behavioral Healthcare Hospital
Utilization Review Clinician (Santa Rosa)
Sacramento Behavioral Healthcare Hospital, Santa Rosa, California, us, 95402
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Sacramento Behavioral Healthcare Hospital provided pay range This range is provided by Sacramento Behavioral Healthcare Hospital. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $65,520.00/yr - $141,804.00/yr
About Us Formerly Aurora Santa Rosa Hospital, SRBHH was opened in 2016 and is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Conveniently located in the North Bay, this hospital consists of 144 acute psychiatric inpatient beds. Santa Rosa Behavioral Healthcare Hospital (SRBHH) is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Conveniently located in the North Bay, SRBHH serves adolescents and adults. We treat both mental health and co-occurring psychiatric and substance abuse conditions.
Position Title Utilization Review Clinician
Pay Range LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC $54.00-64.00 Per Hour
Reports To Director of Utilization Review
Description of Position Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training provided, and understands the potential risks regarding occupational health hazards (e.g., bloodborne pathogen exposures).
Key Responsibilities
Admissions: Conduct admission reviews/Pre-Authorizations in a timely manner
Concurrent Stay Reviews: Conduct concurrent and extended stay reviews for both managed care cases and Kepro counites in a timely manner to ensure that extended stays are medically justified
Payment Appeals: Prepare and submit appeals to third party payers in a timely manner and maintain appropriately detailed records of appeals
Recordkeeping: Maintains appropriate records (AIS, UR forms/charts, Peer to Peer log and Medicare forms) and substantiate activity by documentation that is entered in a clear, concise, organized and timely manner.
Medical Necessity: Attend Treatment Team on a daily basis and collaborate with clinical team to answer clinical questions related to medical necessity and patient status and to advise on authorization status and denial risks.
Collaboration: Interact with physicians, case managers and other hospital colleagues in a timely, positive manner to resolve UM and patient status issues. Document UM, quality and risk concerns and refer to appropriate departments as applicable for follow up.
Denial Risk: On a daily basis, identify cases that are at risk for denial and track in log daily
Knowledge: Demonstrate a working knowledge of Medical Necessity and regulatory standards (Medicare, Medicaid and Managed Care)
Training: Provide staff in-service training and education
Upholds the Organization's ethics and customer service standards
Performs related duties, as requested
Requirements Education/Licensure
Current license as an LCSW, ASW, AMFT, LMFT, RN, LVN, LPT, or LPCC.
Preferred: Master's degree in Social Work, Behavioral Science, or related field.
Current Cardiopulmonary Resuscitation (CPR) certification required, or obtained within initial orientation period.
Knowledge and Experience
Demonstrated knowledge of health care service delivery systems and third-party reimbursement
Two or more years' experience working in managed care environment
Ability to apply and interpret admission and continued stay criteria
Strong understanding of admission and discharge function
Familiarity with medical terminology, diagnostic terms and treatment modalities
Knowledge of medical record keeping requirements
Ability to comprehend psychiatric evaluations, consults, and lab results
Skills and Abilities
Maintains confidentiality of patients at all times
Ability to cope well with stress and have a strong sense of compassion
Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint.)
Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
Strong written and verbal communication skills
Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
Ability to work independently and as part of a team
Good judgment, problem solving and decision-making skills
Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
Ability to work in a fast-paced, expanding organization.
Physical Requirements
Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
Give and follow verbal and written instructions with attention to detail and accuracy.
Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information
Vision: see details of objects at close range
Coordinate multiple tasks simultaneously.
Reach forward, up, down, and to the side.
Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day
Lift up to five (5) pounds
Benefits
Health Insurance
Vision Insurance
Dental Insurance
401k Retirement Plan
Healthcare Spending Account
Life Insurance (Supplemental Life, Term and Universal plans are also available)
Short and Long-Term Disability (with additional buy-in opportunities)
PTO Plan with Holiday Premium Pay
Discounted Cafeteria Meal Plan
Tuition Reimbursement
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
IT Services and IT Consulting
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Get AI-powered advice on this job and more exclusive features.
Sacramento Behavioral Healthcare Hospital provided pay range This range is provided by Sacramento Behavioral Healthcare Hospital. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $65,520.00/yr - $141,804.00/yr
About Us Formerly Aurora Santa Rosa Hospital, SRBHH was opened in 2016 and is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Conveniently located in the North Bay, this hospital consists of 144 acute psychiatric inpatient beds. Santa Rosa Behavioral Healthcare Hospital (SRBHH) is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Conveniently located in the North Bay, SRBHH serves adolescents and adults. We treat both mental health and co-occurring psychiatric and substance abuse conditions.
Position Title Utilization Review Clinician
Pay Range LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC $54.00-64.00 Per Hour
Reports To Director of Utilization Review
Description of Position Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training provided, and understands the potential risks regarding occupational health hazards (e.g., bloodborne pathogen exposures).
Key Responsibilities
Admissions: Conduct admission reviews/Pre-Authorizations in a timely manner
Concurrent Stay Reviews: Conduct concurrent and extended stay reviews for both managed care cases and Kepro counites in a timely manner to ensure that extended stays are medically justified
Payment Appeals: Prepare and submit appeals to third party payers in a timely manner and maintain appropriately detailed records of appeals
Recordkeeping: Maintains appropriate records (AIS, UR forms/charts, Peer to Peer log and Medicare forms) and substantiate activity by documentation that is entered in a clear, concise, organized and timely manner.
Medical Necessity: Attend Treatment Team on a daily basis and collaborate with clinical team to answer clinical questions related to medical necessity and patient status and to advise on authorization status and denial risks.
Collaboration: Interact with physicians, case managers and other hospital colleagues in a timely, positive manner to resolve UM and patient status issues. Document UM, quality and risk concerns and refer to appropriate departments as applicable for follow up.
Denial Risk: On a daily basis, identify cases that are at risk for denial and track in log daily
Knowledge: Demonstrate a working knowledge of Medical Necessity and regulatory standards (Medicare, Medicaid and Managed Care)
Training: Provide staff in-service training and education
Upholds the Organization's ethics and customer service standards
Performs related duties, as requested
Requirements Education/Licensure
Current license as an LCSW, ASW, AMFT, LMFT, RN, LVN, LPT, or LPCC.
Preferred: Master's degree in Social Work, Behavioral Science, or related field.
Current Cardiopulmonary Resuscitation (CPR) certification required, or obtained within initial orientation period.
Knowledge and Experience
Demonstrated knowledge of health care service delivery systems and third-party reimbursement
Two or more years' experience working in managed care environment
Ability to apply and interpret admission and continued stay criteria
Strong understanding of admission and discharge function
Familiarity with medical terminology, diagnostic terms and treatment modalities
Knowledge of medical record keeping requirements
Ability to comprehend psychiatric evaluations, consults, and lab results
Skills and Abilities
Maintains confidentiality of patients at all times
Ability to cope well with stress and have a strong sense of compassion
Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint.)
Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
Strong written and verbal communication skills
Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
Ability to work independently and as part of a team
Good judgment, problem solving and decision-making skills
Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
Ability to work in a fast-paced, expanding organization.
Physical Requirements
Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
Give and follow verbal and written instructions with attention to detail and accuracy.
Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information
Vision: see details of objects at close range
Coordinate multiple tasks simultaneously.
Reach forward, up, down, and to the side.
Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day
Lift up to five (5) pounds
Benefits
Health Insurance
Vision Insurance
Dental Insurance
401k Retirement Plan
Healthcare Spending Account
Life Insurance (Supplemental Life, Term and Universal plans are also available)
Short and Long-Term Disability (with additional buy-in opportunities)
PTO Plan with Holiday Premium Pay
Discounted Cafeteria Meal Plan
Tuition Reimbursement
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
IT Services and IT Consulting
Referrals increase your chances of interviewing at Sacramento Behavioral Healthcare Hospital by 2x
#J-18808-Ljbffr