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.
- Pay Range: $50/hr. to $60/hr.
Work Schedule: Monday to Friday from 8:00 a.m. to 4:30 p.m.
Responsibilities:
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Admissions: Conduct admission reviews
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Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews
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Payment Appeals: Prepare and submit appeals to third party payers
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Recordkeeping: Maintains appropriate records of the Utilization Review Department
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Training: Provide staff in-service training and education
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Maintains confidentiality of patients at all times
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Ability to cope well with stress and have a strong sense of compassion
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Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
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Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint)
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Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
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Strong written and verbal communication skills
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Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
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Ability to work independently and as part of a team
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Good judgment, problem solving and decision-making skills
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Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others
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Ability to work in a fast-paced, expanding organization
Skills:
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Demonstrated knowledge of health care service delivery systems and third party reimbursement
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Two or more years’ experience working in managed care environment
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Ability to apply and interpret admission and continued stay criteria
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Strong understanding of admission and discharge function
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Familiarity with medical terminology, diagnostic terms and treatment modalities
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Knowledge of medical record keeping requirements
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Ability to comprehend psychiatric evaluations, consults, and lab results
Requirements
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Current California Registered Nurse License
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BLS (Basic Life Support ) Certification for Healthcare Providers - American Heart Association
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1 year work experience with Utilization Review-Case Management
Benefits
- 401K Retirement Plan
- Health Insurance
- Vision Insurance
- Dental Insurance
- Pet Insurance
- Healthcare Spending Account & Dependent Care Spending Account
- Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
- PTO Plan with Holiday Premium Pay
- PTO Cash Out option
- Sick Pay
- Short and Long-Term Disability (with additional buy-in opportunities)
- Tuition Reimbursement
- Employee Assistance Program
- ID Theft Protection
