Utilization Review Specialist - Behavioral Health (Onsite)
Harboroaks
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Job summary
San Jose Behavioral Health is seeking an Utilization Review Specialist - Full Time for its 133-bed acute psychiatric hospital in San Jose. This onsite role supports the Utilization Department in coordinating inpatient care, reviews, and discharge planning to ensure appropriate utilization and compliance.
The role requires nursing education, relevant regulatory licenses, and experience in utilization management or related fields.
Qualifications
- Associate Degree in Nursing (LPN/LVN/RN) required.
- Bachelor's or Master's in Social Work, Behavioral Health or Nursing preferred.
- Two or more years' experience with the facility population preferred.
- Previous utilization management experience preferred.
Responsibilities
- Act as liaison between managed care organizations and clinical staff.
- Review insurance plans for certification requirements and coordinate communications.
- Monitor length of stay and inform staff of issues affecting stay.
- Gather data and reports on utilization, discharges and service quality.
- Conduct quality reviews for medical necessity and services.
- Facilitate peer review calls with external organizations.
- Initiate and complete formal appeal processes for denials or continued stay.
- Assist admissions with pre-certifications.
- Provide ongoing staff training on documentation and stay criteria.
Skills
Education
Job description
San Jose Behavioral Health is seeking an Utilization Review Specialist - Full Time for its 133-bed acute psychiatric hospital in San Jose. This onsite role supports the Utilization Department in coordinating inpatient care, reviews, and discharge planning to ensure appropriate utilization and compliance.
The role requires nursing education, relevant regulatory licenses, and experience in utilization management or related fields.
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