Utilization Management Specialist

2 days ago


Sacramento, California, United States Universal Health Services Full time
Job Summary

We are seeking a highly skilled Utilization Management Coordinator to join our team at Sierra Vista Hospital. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of care.

Responsibilities
  • Manage and review patient utilization of resources to ensure clinical appropriateness and maximize effectiveness of care.
  • Function as a liaison between payors, the business office, and treatment team to provide information and feedback to support optimum patient care and reimbursement.
  • Review and obtain authorization for services through all levels of care and aftercare review with payor sources.
Qualifications
  • Bachelor's degree from an accredited college or university in nursing, or master's degree in social work, mental health, or a related field.
  • Minimum one year experience with communication with external review organizations or comparable entities, or four years direct clinical experience in a psychiatric or mental health setting.
  • RN, LCSW, MFT, MSW degree, LVN/LPT or applicable license.
  • Training in Crisis Prevention Intervention (CPI) within the first 30 days of employment.
What We Offer

Sierra Vista Hospital is a 171-bed psychiatric care facility located in south Sacramento, offering a full range of mental health services. As a member of our team, you will have the opportunity to work with a dedicated team of healthcare professionals who are passionate about delivering high-quality care to our patients.



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