Overview Coordinates utilization review activities to ensure clinical documentation is accurate to secure mental health and addiction treatment authorizations for patients from government or commercial health plans. This position serves as the primary liaison between Medical Staff, Treatment Team, and 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 with the Manager of Business Operations and their team to secure authorizations for treatment and address denials of care. Initiates appeal processes and monitors responses. Communicates utilization review and reimbursement issues, trends and patterns to the Manager of Medical Staff and Clinical Effectiveness.
Education
Graduate of Psychiatric Technician Program
Experience
1-year Behavioral Health Experience strongly preferred
Licenses/Certification
Psychiatric Technician - California Board of Vocational Nursing and Psychiatric Technicians
BLS Basic Life Support - American Heart Association
Skills – Core
Good communication, documentation and organizational skills.
Self-motivation and independent decision-making skill.
Demonstrates personal maturity, independent judgement and integrity.
Days worked per week: Monday - Friday
Work Shift: 08:00 - 16:30 (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.