Clinical Utilization Specialist
3 hours ago
Mental Health Resource Center Inc is seeking a skilled Utilization Management Reviewer to join our team. As a key member of our clinical team, you will play a vital role in ensuring the efficient and effective use of our mental health services.
Responsibilities- Conduct thorough reviews of medical records to ensure compliance with established criteria and guidelines.
- Participate in treatment team meetings to discuss patient care and make recommendations for improvement.
- Communicate effectively with insurers and third-party payers to resolve issues and ensure seamless care transitions.
- Coordinate on-site reviews of medical records with external reviewers to ensure accuracy and consistency.
- Document and update patient and provider information in our electronic records system.
- Investigate complaints and grievances, and report findings to the Utilization Management Manager.
- Develop and maintain effective working relationships with staff members to ensure professional interactions.
To be considered for this role, you must have one of the following qualifications:
- Registered Nurse: Associate Degree in Nursing required, with one year of experience in psychiatric nursing and a valid Florida RN License.
- Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required, with two years of experience in psychiatric nursing and a valid Florida LPN License.
- Bachelor's degree in Psychology or Human Services related field required, with five years of experience in the mental health field and UM experience preferred.
- Master's degree in Psychology or Human Services related field required, with three years of experience in the mental health field and UM experience preferred.
This role requires excellent communication skills and the ability to interact effectively with individuals with mental illness. You must be able to work in a fast-paced environment and contribute to the completeness and confidentiality of clinical records.
Work EnvironmentThis is a full-time position, Monday through Friday, 7:00am to 3:30pm. Renaissance Behavioral Health Systems and Mental Health Resource Center Inc are Equal Opportunity Employers.
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