POSITION SUMMARY
The Utilization Review Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria and meeting the daily deadlines to obtain authorizations and complete other pertinent processes, under the supervision of the Director of Utilization Review.
Education / Licensure
Candidate will possess an accredited master’s degree in social work, mental health or a related field, or be licensed as a Registered Nurse in the State of Wisconsin. One year’s experience with communication with external review organizations or comparable entities and direct clinical experience in a psychiatric or mental health setting is preferred.
Skills
1) Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria.
2) Ability to communicate professionally and effectively, orally, in person, and in writing, with multidisciplinary team members, managed care organizations and business office, providing needed information in a logical, concise manner using technical language that accurately describes patient’s condition and need for hospitalization.
3) Working knowledge of payor resources and financial planning.
4) Ability to organize and prioritize workload to meet deadlines, orchestrate a myriad of activities and to manage multiple priorities within complex and changing systems; 5) Able to self-regulate and facilitate helpful management dynamics during stressful situations.
Additional Requirements
Timely renew and maintain an active registered nursing license, cardiopulmonary resuscitation for healthcare professional’s certification, professional skills verification and Crisis Prevention Institute “CPI” (psychiatric crisis management) certification.
AGES and POPULATIONS SERVED
Willow Creek Behavioral Health and its subsidiaries provides access and services to all persons meeting admission and continuing stay criteria without regards to race, color, religion, sex, sexual orientation, age, marital status, national origin, military status, veteran status, medical status, handicap or mental/physical disability. Our patient population reflects the fullest diversity of the community in which we serve. All staff are to conduct themselves with respect and consideration for others, and to appropriately intervene in situations below this standard.
ESSENTIAL JOB FUNCTION AND RESPONSIBILITIES
Customer Service
Utilization Review:
Leadership
Medical Records and Confidential Communication
NOTE: The essential job functions of this position are not limited to the duties listed above.
DEMANDS / WORK ENVIRONMENT
Environment: Located in an indoor climate-controlled environment with constant exposure to patients with a psychiatric diagnosis along with medical complications. Patient acuity will at times increase environmental stressors and sound volume.
Sight: Vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Hearing: Must be able to hear and respond to others in person, by telephone, alarms and to medical equipment/devices.
OSHA Category 1: Tasks occasionally may involve exposure to blood, body fluids, tissue and other potentially infectious materials. The use of universal precautions, personal protective equipment, regular hand washing, and following manufacturing guidelines can greatly reduce any exposure risk.
Physical: This position requires regular sitting, stooping, standing, walking and lifting/reaching/carrying materials up to 35 lbs. Psychiatric emergencies require the use of safe physical techniques to lift and/or move patients in excess of 100 lbs. Some patient care settings may have patients requiring assistance in repositioning and transferring from bed to chair.
Willow Creek is an Equal Opportunity Employer.
PI177394846
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