Licensure: Licensure in the State of Nevada as an intern in the area of Clinical Social Work (LCSW), or Marriage and Family Therapy (MFT)
Education: Master’s degree in Social Work or other health related field.
Experience: Some clinical experience in a psychiatric or mental health treatment setting.
Current Job Opening
Per Diem Utilization Review Coordinator
The Utilization Review Coordinator provides admission and continued stay reviews in conjunction with utilization practices and discharge planning. Serves as a liaison between the multi-disciplinary team and the reimbursement agents to assure medical necessity for treatment and appropriateness of resources utilized.
1.Performs admission reviews using the established specific criteria.
2.Performs concurrent reviews using the established specific criteria.
3.Performs retrospective reviews using the established program; forwarding records as requested.
4.Ensures information is accurate and timely.
5.Coordinates information and findings with the Business Office to recognize and resolve certification problems.
6.Schedules the completion of reviews to ensure a continuum of reviews, as per plan.
7.Increases proficiency through attendance of available in-service and seminar presentations related to UR, mental health diagnosis and treatment.
1.Makes suggestions and recommendations seeking to support and enhance facility programs.
2.Communicates with all members of the multi-disciplinary team regarding documentation deficiencies in a timely manner.
3.Communicates with all Therapists and Therapeutic Services Director & MD’s regarding problems that jeopardize continued stay.
4.Communicates with the physicians regarding documentation issues and for PA calls
5.Communicates relevant information to other department managers, staff, physicians and administration to ensure smooth operation of day-to-day activities and implementation of short/long range operational goals.
6.Works closely with the Physicians, Director of Therapeutic Services, the Director of UR and Program Therapists to ensure the discharge for all patients is a smooth process that begins at admission.
7.Attends the first treatment team meeting for each patient, and begins the Aftercare Plan. Attends treatment team meetings throughout the patient’s stay.
1.Communicates via phone ensuring appropriate phone etiquette.
2.Review emails and phone messages in a timely fashion.
3.Maintains documentation of conversations regarding the admissions process.
4.Investigates insurance company denials and initiates appeal process.
5.Follows the established Utilization Review plan and refers problem cases to the UR Manager, Physicians, Therapeutic Service Director, and treatment team.
6.Assists with problems encountered during on site reviews by third party payors or review organizations.
7.Checks for properly signed consents before discussing the case with others to be HIPAA compliant.
8.Provides ongoing training to the Clinical Team as indicated.
9.Performs other duties in support of the Utilization Review process.
Education: Graduate from an accredited program of professional nursing or masters degree in social work pr related field required.
Experience: Three (3) years experience in a mental health/health facility. Minimum three (3) years experience as a Registered Nurse, Licensed Clinical Social Worker, Marriage and Family Therapist or Licensed Psychologist. Utilization Review experience strongly preferred.
Licensure: Current licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Marriage and Family Therapist (MFT) or Licensed Psychologist in the State of Nevada.
Interested applicants should apply online at www.willowspringscenter.com
. Resumes will not be accepted in lieu of the online application.