Behavioral Health Utilization Review Specialist

Sutter Health; Berkeley (CA); On-site; USD 67,000 - 101,000; Full time

Job summary

Sutter Health, at ABMS C-Alta Bates Herrick Campus in Berkeley, CA, seeks a utilization management professional to justify admissions and manage continued stay decisions. You will develop and monitor systems for appeal/denial processes, coordinate care utilization, and liaise with payers and hospital departments to ensure optimal service and reimbursement.

The role requires a Master’s in Social Work or related field, strong data interpretation, and proficiency with clinical/administrative

Qualifications

• Master's in Social Work or related field is required.
• Working knowledge of medical terminology and current treatments.
• Ability to interpret data and instructions from various sources.
• Strong written and verbal communication skills with teammates and hospital staff.
• Good time management and ability to prioritize within policies.
• Proficient in computer applications including Crystal Reports, Midas Plus, Excel, Sunrise, MS Word, PCIS, InterQual.
• Ability to work independently and as part of a team while handling multiple tasks.
• Protect the privacy of patients' PHI.
• Build collaborative relationships to meet departmental and corporate objectives.

Responsibilities

• Accumulates, interprets, and documents information to justify hospital admission and continuation of care.
• Coordinates utilization management activities and tracks data trends.
• Acts as liaison between payers, business office, admissions staff, and review organizations.
• Ensures documentation meets privacy and safety standards while delivering quality care.

Skills

Medical terminology

Data interpretation

Communication skills

Time management

Team collaboration

PHI privacy

Problem solving

Education

Master's in Social Work

Tools

Crystal Reports

Midas Plus

Excel

Sunrise

MS Word

PCIS

InterQual

Job description

Sutter Health, at ABMS C-Alta Bates Herrick Campus in Berkeley, CA, seeks a utilization management professional to justify admissions and manage continued stay decisions. You will develop and monitor systems for appeal/denial processes, coordinate care utilization, and liaise with payers and hospital departments to ensure optimal service and reimbursement.

The role requires a Master’s in Social Work or related field, strong data interpretation, and proficiency with clinical/administrative