Utilization Review Specialist
Company: Orange County Behavioral Health
Location: Aliso Viejo
Posted on: January 16, 2022
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.
KEY RESPONSIBILITIES :
Admissions: Conduct admission reviews.
Concurrent/Stay Reviews: Conduct concurrent and extended stay
Payment Appeals: Prepare and submit appeals to third party
Recordkeeping: Maintains appropriate records of the Utilization
Training: Provide staff in-service training and education.
Education and Licensing:
Current license as RN, LVN/LPT, LCSW,
Preferred; Master's degree in Social Work, Behavioral Science, or
Current CPR certification.
Crisis Prevention Intervention (CPI) (or equivalent as approved by
CNO) obtained within 60 days of hire
Knowledge and Experience:
Demonstrated knowledge of health care service delivery systems and
third party reimbursement
Two or more years' experience working in managed care
Ability to apply and interpret admission and continued stay
Strong understanding of admission and discharge function
Familiarity with medical terminology, diagnostic terms and
Knowledge of medical record-keeping requirements
Ability to comprehend psychiatric evaluations, consults, and lab
Skills and Abilities:
Maintains confidentiality of patients at all times.
Ability to cope well with stress and have a strong sense of
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
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 :
While performing the duties of this job, this position is
frequently required to do the following:
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.
401k Retirement Plan
Healthcare Spending Account
Dependent Care Spending Account
Life Insurance (Supplemental Life, Term and Universal plans are
Short and Long-Term Disability (with additional
Keywords: Orange County Behavioral Health, East Los Angeles , Utilization Review Specialist, Other , Aliso Viejo, California
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