Utilization Reviewer
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Description
****Average hourly rate is $22.60 (including wage, incentives, bonuses, overtime, shift differential, etc.)****
Utilization Reviewer
Pathway Family Services, LLC. provides resources for youth and families through their Independent Living Program, TRAIL (Teens Reaching Adult Independent Living), Psychiatric Residential Treatment Facility, Qualified Residential Treatment Program (QRTP), outpatient services and specialized foster care services.
Qualifications:
Bachelor's degree in nursing, social work, psychology, or a related field.
A minimum of three years of experience in a similar role within a psychiatric or behavioral health setting, with a focus on adolescent care.
Must be at least 21 years of age based on state requirement of being at least 3 years older than the oldest resident.
Benefits:
- Competitive pay
- Flexible Schedule
- Health Insurance
- Dental Insurance
- Vision Insurance
- Company paid Life insurance
- 401(k) Match
- 25 days of personal leave in first year of employment
- Longevity bonus
- Employee Assistance Program
- Flexible Spending Program
- Referral program
The Family Initiative, Inc. is the parent company providing services in Kansas, Nebraska, Oklahoma, and Texas. We provide service to these areas through our affiliates: TFI Family Connections in Oklahoma and Texas Family Initiative in Texas. Pathway Family Services is an affiliate in Kansas offering additional services to youth and families. Mainstream Nonprofit Solutions is an affiliate supporting the TFI Family of Companies and other Nonprofits.
As a Utilization Reviewer, you will be responsible for evaluating the appropriateness and necessity of treatment services provided to adolescent residents. This role will involve collaborating with the clinical team to ensure that treatment plans align with regulatory standards and best practices in the field of children and adolescent psychiatric care.
- Conduct comprehensive reviews of resident treatment plans to ensure compliance with facility guidelines and industry regulations.
- Collaborate with clinical staff to assess the effectiveness of treatment interventions and recommend adjustments as necessary.
- Perform thorough assessments of patient records, including progress notes and discharge summaries, to determine the quality and efficiency of care provided.
- Communicate effectively with insurance providers and external agencies to obtain authorization for necessary treatment services.
- Monitor the length of stay for each resident, making recommendations for appropriate extensions or terminations of care based on established criteria.
- Participate in regular team meetings to discuss resident progress, barriers to treatment, and strategies for optimizing care delivery.
- Maintain accurate and detailed documentation of all review activities, ensuring confidentiality and compliance with privacy regulations.
- Stay updated on current trends and developments in adolescent psychiatric care and utilization review guidelines effectively.
- Contribute to the development and implementation of quality improvement initiatives aimed at enhancing the overall standard of care provided to residents.
- Ensures all organizational activities are carried out in compliance with local, state, and federal, and accreditation agency regulations and laws governing business operations.
- Will be required to travel in order to attend meetings, training, or conduct business off site. Must have a valid driver's license and meet agency underwriting standards if driving on agency business. Not required to transport clients.
- Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
- Advocates, promotes, and practices cultural sensitivity and responsiveness in all day-to-day interactions.
If you want to make a difference in a child’s life, join our team today
TFI is an Equal Opportunity Employer.
To apply, please visit www.tfifamily.org/employment
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