Utilization Review Specialist- Ohana
Montage Health’s application process has changed effective 12/20/2019.
If you submitted an online application prior to 12/20/2019, you will be required to recreate your profile information if you want to apply to any new positions. You will no longer have access to your previously saved profiles and applications. Current employees applying for transfer into a posted position must also create a profile.
- Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
- Excellent Team Orientated Culture
- Free Gym for Employees
Under the leadership of the Director of Operations, the Utilization Review Specialist facilitates quality care by screening the admission and continued stay of patients utilizing medical necessity criteria. The Utilization Specialist complies with regulatory requirements and supports systems and processes to meet regulations.
Must have strong interpersonal skills, flexibility, curiosity, high energy, humor and humility. All team members have the mission of Ohana at the forefront of every decision and engage in a culture of continuous learning and hard work. Team members maintain an unwavering commitment to family centered care and delivering quality outcomes, good public/customer relations and a broad clinical knowledge.
Must have 3 years in behavioral health utilization review or quality assurance experience. Broad clinical expertise to evaluate patient diagnosis and treatment plan and outcomes utilizing established criteria. Effective communication and public relations skills. Ability to work as an integral member of the interdisciplinary assessment team. Strong organization skills. Knowledge of financial reimbursement - state, federal and commercial insurance requirements preferred. Knowledge of Government programs, rules and regulations, and commercial insurance requirements preferred.
Graduate degree in behavioral health sciences i.e. social work/psychology required or Bachelor’s degree in Nursing required.
One of the following licenses is required: State of California RN license, PsyD., Ph.D, LCSW, LMFT, LCPC.
Assigned Work Hours: