Coordinator - Utilization Review - CMC Utilization Management - Full Time - 8 Hour - Days at John Muir Health

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

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:

• 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:

08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:

$40.35 - $54.46

Hourly

Scheduled Weekly Hours:

40