Bayside Marin Treatment Center
Utilization Review Specialist
Bayside Marin Treatment Center, San Rafael, California, United States, 94911
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Utilization Review Specialist
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Bayside Marin Treatment Center 2 days ago Be among the first 25 applicants Join to apply for the
Utilization Review Specialist
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Bayside Marin Treatment Center Get AI-powered advice on this job and more exclusive features. Purpose Statement
Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Purpose Statement
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Essential Functions
Act as liaison between managed care organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact 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 required by the facility leadership or corporate office. Conduct quality reviews for medical necessity and services provided. Facilitate peer review calls between 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.
Other Functions
Perform other functions and tasks as assigned.
Education/Experience/Skill Requirements
Required Education: High school diploma or equivalent. Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
Licenses/Designations/Certifications
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I 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 required (training available upon hire and offered by facility. First aid may be required based on state or facility requirements.
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.
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.
AHMKT
Seniority level
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Employment type Full-time Job function
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Utilization Review Specialist
role at
Bayside Marin Treatment Center 2 days ago Be among the first 25 applicants Join to apply for the
Utilization Review Specialist
role at
Bayside Marin Treatment Center Get AI-powered advice on this job and more exclusive features. Purpose Statement
Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Purpose Statement
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Essential Functions
Act as liaison between managed care organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact 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 required by the facility leadership or corporate office. Conduct quality reviews for medical necessity and services provided. Facilitate peer review calls between 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.
Other Functions
Perform other functions and tasks as assigned.
Education/Experience/Skill Requirements
Required Education: High school diploma or equivalent. Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
Licenses/Designations/Certifications
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I 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 required (training available upon hire and offered by facility. First aid may be required based on state or facility requirements.
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.
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.
AHMKT
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Other Industries Mental Health Care Referrals increase your chances of interviewing at Bayside Marin Treatment Center by 2x Sign in to set job alerts for “Specialist” roles.
San Francisco, CA $93,000.00-$150,000.00 2 weeks ago San Francisco, CA $60,000.00-$85,000.00 6 days ago San Francisco, CA $40.87-$45.67 5 days ago San Francisco, CA $70,500.00-$94,400.00 17 hours ago San Francisco, CA $81,000.00-$100,000.00 1 month ago San Francisco, CA $81,000.00-$100,000.00 1 month ago Policy Escalation Specialist, Trust and Safety, YouTube
San Bruno, CA $90,500.00-$130,000.00 1 day ago San Francisco, CA $80,000.00-$155,000.00 6 months ago San Francisco, CA $52,000.00-$75,000.00 3 weeks ago Customer Experience Operations Specialist (Remote, West Coast US)
San Francisco, CA $80,000.00-$125,000.00 2 weeks ago San Francisco, CA $22.00-$23.00 2 weeks ago San Francisco, CA $110,000.00-$140,000.00 2 weeks ago Customer Success Specialist (Full-Time/Intern)
San Francisco, CA $60,000.00-$90,000.00 3 weeks ago South San Francisco, CA $100,000.00-$135,000.00 1 month ago San Francisco, CA $114,000.00-$163,000.00 22 hours ago San Francisco, CA $90,000.00-$100,000.00 2 weeks ago Executive Events and Marketing Coordinator
San Francisco, CA $80,000.00-$120,000.00 1 month ago San Francisco, CA $28.50-$31.00 2 weeks ago Investigative Analyst (Criminal Analyst)
Business Intelligence Analyst, Growth Marketing
San Francisco, CA $113,000.00-$132,000.00 1 month ago San Francisco, CA $62,000.00-$120,000.00 2 weeks ago San Francisco, CA $30.00-$40.00 2 weeks ago San Francisco, CA $44.00-$46.00 4 hours ago San Francisco, CA $65,000.00-$70,000.00 2 days ago Oakland, CA $75,000.00-$135,000.00 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr