Psychiatric Service Utilization Specialist
3 days ago
About the Position
This is a full-time position that requires the ideal candidate to have excellent communication and problem-solving skills, as well as the ability to work independently and as part of a team.
Key Responsibilities- Review medical records and attend treatment team meetings to review utilization of resources and the level of care provided.
- Ensure utilization and level of care are appropriate based on the diagnosis, needs, age, and culture of the individual.
- Carry out telephone and written communication with insurers and third-party payers regarding referrals, admissions, medication changes, discharges, and changes in level of care.
- Coordinate on-site review of medical records with reviewers from third-party payers.
- Document, update, and manage patient and provider information using internal electronic records system.
- Coordinate psychiatric consultations between internal and external providers.
- Investigate complaints, grievances, and medication variances. Report findings to Utilization Management Manager and complete necessary follow-up.
- Respond to changing needs of departments (program design, forms development, reporting mechanisms, etc.) Establish and maintain effective working relationships with staff members to assure professional interactions.
- Registered Nurse: Associate Degree in Nursing required.
- One year experience in psychiatric nursing required. Valid Florida RN License required.
- Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required.
- Two years experience in psychiatric nursing required. Valid Florida LPN License required.
- Bachelor's degree in Psychology or Human Services related field required.
- Five years experience in the mental health field required. UM experience preferred.
- Master's degree in Psychology or Human Services related field required.
- Three years experience in the mental health field required. UM experience preferred.
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