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POSITION SUMMARY:

The Utilization Review Specialist - Behavioral Health works collaboratively with Administration, Coding, Physicians, Nursing, Social Work, Quality Department and ancillary staff. Performs concurrent analytical review of the medical record to assure complete documentation to reflect medical necessity of all conditions and treatments from point of entry to discharge. Performs timely utilization and clinical reviews and communicates with insurance/ managed care entities to secure certification/ reimbursement. Maintains data for required auditing, utilization review, reporting and performance improvement. As prescribed by Social Services, Physicians and LIPs, assists in discharge planning with communication and securing appointments with next level of care providers, durable medical equipment or medication authorizations, communication with pharmacies, assist in facilitating placement or other referrals. Assist with Comfort Calls to former patients.