Utilization Review Clinician — Mental Health Authorization

Universal Hospital Services Inc.; Sacramento (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Heritage Oaks Hospital is seeking a Utilization Review Clinician to monitor resource utilization and ensure appropriate care across levels of treatment. You will liaise between payors, the business office and the treatment team to secure timely authorizations and feedback that supports patient care and reimbursement.

The role requires a Master’s degree in social work or a related field, MSW licensure, and experience with external review organizations or four years in a psychiatric setting.

Qualifications

• Master’s degree in social work or related field.
• 1 year (or 4 years in psychiatric setting) direct clinical experience or external review authorization coordination experience.
• MSW licensure required; Handle with Care (HWC) training within 30 days; CPR certification.

Responsibilities

• Manage, review and monitor utilization of resources to maximize appropriateness of care.
• Serve as liaison between payors, business office and treatment team to facilitate care and reimbursement.
• Coordinate pre-authorization with Assessment & Referral; communicate insurance benefits and coverage; attend treatment planning meetings and oversee care coordination.

Skills

Effective communication

Team coordination

Pre-authorization experience

Education

Master’s degree in social work or related field

Job description

Heritage Oaks Hospital is seeking a Utilization Review Clinician to monitor resource utilization and ensure appropriate care across levels of treatment. You will liaise between payors, the business office and the treatment team to secure timely authorizations and feedback that supports patient care and reimbursement.

The role requires a Master’s degree in social work or a related field, MSW licensure, and experience with external review organizations or four years in a psychiatric setting.