Utilization Management Reviewer

Mental Health Resource Center, Inc.; Jacksonville (FL); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

403b

PTO

Paid Holidays

Flexible Spending Account

Employee Assistance Program

Job summary

Mental Health Resource Center is seeking a Utilization Management Reviewer to monitor the utilization of clinical services, review medical records, and participate in treatment team meetings. The crisis stabilization units serve adults, adolescents, and children, with typical stays of 3–5 days.

The role operates in a fast-paced, team-oriented environment. Responsibilities include coordinating with insurers, documenting in the electronic records system, and coordinating psychiatric consultations.

Qualifications

• RN: Associate Degree in Nursing; One year experience in psychiatric nursing; Florida RN license required.
• LPN: Graduation from an accredited PN program; Two years psychiatric nursing experience; Florida LPN license required.
• Master’s: Three years experience in mental health; UM experience preferred.

Responsibilities

• Reviews medical records and attends treatment team meetings to review utilization and level of care.
• Communicates with insurers and third-party payers about referrals, admissions, medication changes, discharges and changes in level of care.
• Coordinates on-site reviews of medical records with payer reviewers.
• Documents and manages patient/provider information in internal records system.
• Coordinates psychiatric consultations between internal and external providers.
• Investigates complaints, grievances, and medication variances; reports findings to UM Manager and follows up.
• Responds to changing needs of the department and maintains relationships with staff.

Skills

Communication skills

Education

Registered Nurse (RN)

Licensed Practical Nurse (LPN)

Master’s degree in Psychology or Human Services

Job description

Company Overview

Mental Health Resource Center is a not-for-profit Florida corporation that provides a wide range of mental health and behavioral health care services to the community such as 24-hour emergency services, inpatient psychiatric services for children, adolescents, and adults as well as outpatient services such as medication management, case management, and counseling.

Benefits & Perks

• Medical, Dental, and Vision Insurance
• Life Insurance
• Disability Insurance
• 403b
• PTO
• Paid Holidays
• Flexible Spending Account
• Employee Assistance Program

Job Summary

Mental Health Resource Center is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC), using predetermined criteria, review of medical records, and regular participation in treatment team meetings.

The crisis stabilization units provide services for adults, adolescents, and children. Most patients are admitted involuntarily to the facility via the Baker Act, the mental health act of Florida. The normal length of stay on the unit for patients is typically 3-5 days. Due to the types of services provided, crisis stabilization units are a fast paced working environment and present employees with challenging and rewarding opportunities. Employees work together and support one another in a friendly, team oriented atmosphere.

Responsibilities

• Reviews medical records and attends treatment team meetings to review utilization of resources and the level of care provided. Ensures utilization and level of care are appropriate based on the diagnosis, needs, age and culture of the individual.
• Carries out appropriate telephone and written communication with insurers and third party payers regarding referrals, admissions, medication changes, discharges and changes in level of care.
• Coordinates on-site review of medical records with reviewers from third party payers.
• Documents, updates, and manages patient and provider information using internal electronic records system.
• Coordinates psychiatric consultations between internal and external providers.
• Investigates complaints, grievances, and medication variances. Reports findings to Utilization Management Manager and completes necessary follow up.
• Responds to changing needs of the departments (i.e., program design, forms development, reporting mechanisms, etc). Establishes and maintains effective working relationships with staff members to assure professional interactions.

Qualifications

In order to be considered candidates must have one of the following:

• 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.
• Master’s degree in Psychology or Human Services related field: Three years experience in the mental health field required. UM experience preferred.

Requires telephone and person-to-person interactions with individuals with mental illness on locked inpatient units.

Excellent communication skills are essential and this individual must be able to interact appropriately with internal and external customers, including families, caregivers, community service providers, supervisory staff and other department professionals.

Each employee contributes to the completeness and confidentiality of clinical records by ensuring documentation, paperwork and system entries meet internal and external guidelines for content, accuracy and timeliness.

Position Details

This is a full time position, Monday through Friday, 7:00am to 3:30pm.

Renaissance Behavioral Health Systems and Mental Health Resource Center are Equal Opportunity Employers.

Background screening and clearance through the Florida Care Provider Background Screening Clearinghouse is required for all positions: https://info.flclearinghouse.com