Utilization Review-Case Management

4 weeks ago

San Diego, United States Aurora San Diego Hospital Full time
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: $32/hr. to $60/hr

Responsibilities:

  • 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
  • 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

Skills:

  • 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

Requirements

  • Preferred; Current license as RN, LVN/LPT, LCSW
  • Preferred; Master's degree in Social Work, Behavioral Science, or related field
  • Current BLS certification for Healthcare Providers

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

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