• Utilization Review Specialist, Behavioral Health

    Sutter Health (Berkeley, CA)


    We are so glad you are interested in joining Sutter Health!

    Organization:

    ABSMC-Alta Bates Herrick Campus

    Position Overview:

    Accumulates, interprets, and documents timely information to justify acute hospital admission, need for continued stay, and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent review on specific patients. Develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of services and appropriate service reimbursement. Monitors and acts as a liaison between external payers, internal business office, admissions staff, and clerical unit staff to assure that quality care is delivered at the appropriate level of service and that documentation of care meets appropriate standards. Interfaces with hospital administration and unit medical doctors and provides data related to the current management of resources. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care.

     

    **Job Description** :

     

    _These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)._

    DEPARTMENT REQUIRED EDUCATION

    Department, Behavioral Health: Master’s in Social Work or related field

    SKILLS AND KNOWLEDGE:

    Working knowledge of medical terminology, including general knowledge of illnesses, current treatments and their physical and psychosocial sequelae.

     

    Knowledge of alternate levels of care including criteria required for payment and applications processes.

     

    Ability to interpret a variety of data and instructions, furnished in written, oral, diagram, or schedule form.

     

    Possess written and verbal communications skills to communicate with fellow team members, supervisors, patients, and other hospital personnel.

     

    Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines.

     

    Demonstrated knowledge of computer applications, such as Crystal Report writing, Midas Plus, Excel, Sunrise, MS Word, PCIS, and InterQual.

     

    Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.

     

    Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options.

     

    Ensure the privacy of each patient’s protected health information (PHI).

     

    Build collaborates relationships with peers and other staff members to achieve departmental and corporate objectives.

    PHYSICAL ACTIVITIES AND REQUIREMENTS:

    See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/ET7uGCe-tzVGh0qew2nHBZsBpR4VIJFStf2B53bAii2JrA?e=M78vhR)

    Job Shift:

    Days

    Schedule:

    Per Diem/Casual

    Shift Hours:

    8

    Days of the Week:

    Variable

    Weekend Requirements:

    As Needed

    Benefits:

    No

    Unions:

    No

    Position Status:

    Non-Exempt

    Weekly Hours:

    0

    Employee Status:

    Per Diem/Casual

     

    Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

     

    Pay Range is $46.29 to $69.44 / hour

     

    _The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._ _​_