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Utilization Review Specialist

Company: Orange County Behavioral Health
Location: Aliso Viejo
Posted on: January 16, 2022

Job Description:

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.


Admissions: Conduct admission reviews.
Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews.
Payment Appeals: Prepare and submit appeals to third party payers.
Recordkeeping: Maintains appropriate records of the Utilization Review Department.
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 related field.
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 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 :

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.


Health Insurance

Vision Insurance

Dental Insurance

401k Retirement Plan

Healthcare Spending Account

Dependent Care Spending Account

Life Insurance (Supplemental Life, Term and Universal plans are also available)

Short and Long-Term Disability (with additional buy-opportunities

Keywords: Orange County Behavioral Health, Huntington Park , Utilization Review Specialist, Other , Aliso Viejo, California

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