Utilization Review Coordinator - BHC Utilization Management - Per Diem - 8 Hour - Variable Shift

John Muir Health; Concord (CA); On-site; USD 80,000 - 100,000; Part time

Job summary

An established healthcare provider is seeking a dedicated Utilization Review Coordinator to ensure accurate clinical documentation for mental health and addiction treatment authorizations. This role involves close collaboration with medical staff and treatment teams to secure necessary authorizations and address any denials of care. The ideal candidate will possess strong communication and organizational skills, along with a commitment to patient care and integrity. Join a forward-thinking organization where you can make a meaningful impact on patient outcomes in a supportive environment.

Qualifications

• 1-year Behavioral Health Experience preferred.
• California Board of Licensed Vocational Nurse/Licensed Psychiatric Technician required.

Responsibilities

• Coordinate utilization review activities for mental health authorizations.
• Collaborate with Medical Staff and Treatment Team for patient care.

Skills

Good Communication

Documentation Skills

Organizational Skills

Self-motivation

Independent Decision-making

Personal Maturity

Integrity

Education

Graduate of Psychiatric Technician Program

Licensed Vocational Nurse Program

Tools

EPIC

Job description

Coordinates utilization review activities to ensure clinical documentation is accurate to secure mental health and addiction treatment authorizations for patients from their government or commercial health plans. This position is the primary liaison between Medical Staff, Treatment Team, and government or commercial health plans that authorize and reimburse treatment.

Reviews clinical documentation, treatment plans, and monitors care delivery within the medical record, ensuring patients receive necessary treatment at the appropriate level of care based on the clinical documentation. Collaborates and partners closely with the Manager of Business Operations and their team to secure authorizations for treatment and address denials of care. Initiates appeal process and monitors response. Communicates utilization review and reimbursement issues, trends, and patterns to the Manager of Medical Staff and Clinical Effectiveness.

Education:

• Graduate of Psychiatric Technician Program or Licensed Vocational Nurse Program

Experience:

• 1-year Behavioral Health Experience strongly - preferred
• 1-year EPIC experience strongly - preferred

Additional Experience:

• 1-year Utilization Review Experience strongly - preferred

Licenses/Certification:

• California Board of Licensed Vocational Nurse/Licensed Psychiatric Technician
• BLS Basic Life Support - American Heart Association

Skills - Core:

• Good Communication, documentation and organizational skills
• Self-motivation and independent decision-making skills are required
• Demonstrates personal maturity, independent judgement and integrity

Work Shift: 08.0 Per Diem No Waive (United States of America)

Pay Range:

$40.35 - $54.46 Hourly

Offer amounts are based on demonstrated/relevant experience and/or licensure.

Pay will be adjusted to the local market if hired outside of the Bay Area.

Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word 'exempt' on it.

Scheduled Weekly Hours:

0