Utilization Review Coordinator - CMC Utilization Management - Per Diem - 8 Hour - Days
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Overview
Job Description
Job Description:
Coordinates utilization review activities to ensure clinical documentation is accurate to secure mental health and addiction treatment authorizations for patients from their government or commercial health plans. This position is the primary liaison between Medical Staff, Treatment Team, and government or commercial health plans that authorize and reimburse treatment. Reviews clinical documentation, treatment plans, and monitors care delivery within the medical record, ensuring patients receive necessary treatment at the appropriate level of care based on the clinical documentation. Collaborates and partners closely with the Manager of Business Operations and their team to secure authorizations for treatment and address denials of care. Initiates appeal process and monitors response. Communicates utilization review and reimbursement issues, trends and patterns to the Manager of Medical Staff and Clinical Effectiveness.
Education:
- Graduate of Psychiatric Technician Program
Experience:
1-year Behavioral Health Experience strongly- Preferred
1-year EPIC experience strongly- Preferred
Additional Experience:
- 1-year Utilization Review Experience strongly- Preferred
Licenses/Certification:
Psychiatric Technician- California Board of Vocational Nursing and Psychiatric Technicians
BLS Basic Life Support- American Heart Association
Skills- Core:
Good Communication, documentation and organizational skills.
Self-motivation and independent decision-making skill.
Demonstrates personal maturity, independent judgement and integrity.
work shift: Days
Days worked per week: any day of the week, including weekends
Work Shift:
08.0- Per Diem Days No Waive (United States of America)
Pay Range:
$40.35 - $54.46
Hourly
Offer amounts are based on demonstrated/relevant experience and/or licensure.
Pay will be adjusted to the local market if hired outside of the Bay Area.
Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word 'exempt' on it.
Scheduled Weekly Hours:
0
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