Utilization Navigator - Behavioral Health Reimbursement

Harboroaks; Riverside (CA); On-site; USD 42,705 - 68,880; Full time

Benefits offered by this job

Flexible scheduling

Competitive Pay

Employee Assistance Program (EAP)

Job summary

Harboroaks in Riverside, CA, seeks a Utilization Review (UR) Specialist for their inpatient psychiatric facility. You will monitor service utilization, ensure quality reviews, and act as a liaison with managed care organizations. Ideal candidates will have clinical experience and preferred licenses (LPN, RN, LMSW, LCSW, LPC). Benefits include flexible scheduling, competitive pay, and employee assistance programs. Join us in providing high-quality behavioral healthcare.

Qualifications

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and communicate reimbursement requirements.
• Monitor patient length of stay and inform staff on related issues.
• Gather statistical and narrative information for reporting.
• Conduct quality reviews for medical necessity.
• Facilitate peer review calls.
• Complete formal appeal process for denied admissions.
• Assist admissions department with pre-certifications.
• Provide ongoing support and training for staff.

Job description

Harboroaks in Riverside, CA, seeks a Utilization Review (UR) Specialist for their inpatient psychiatric facility. You will monitor service utilization, ensure quality reviews, and act as a liaison with managed care organizations. Ideal candidates will have clinical experience and preferred licenses (LPN, RN, LMSW, LCSW, LPC). Benefits include flexible scheduling, competitive pay, and employee assistance programs. Join us in providing high-quality behavioral healthcare.