Utilization Review Specialist

Westborough Behavioral Healthcare Hospital is looking for a UR Specialist to provide Per Diem coverage.

Benefits Include

• 401K
• Paid Sick Time
• Employee Discount Program
• Employee Assistance Program

Job Description:

The Utilization Review Specialist is responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Monitors the appropriateness of hospital admissions and extended hospitals stays. Completing data collection of demographic, claim and medical information; non-medical analysis; and outcomes reporting.

Essential Duties:

• Initiates authorization requests are complete or requests additional data as necessary.
• Performs concurrent reviews for patients to advocate for authorization for services needed.
• Advises...

The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.

• Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.
• Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.
• Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.
• Monitors all utilization reports to assure compliance with reporting and turnaround times.
• Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.
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About Us

Bakersfield Behavioral Healthcare Hospital, located in Bakersfield, California, is an acute psychiatric and behavioral 90 bed facility situated on 8.8 acres.

We offer inpatient and outpatient services for children, adolescents and adults needing mental/behavioral health, chemical dependency; and co-occurring disorders treatment through our medically supervised detoxification.

Within our Workplace Community, BBHH is striving daily to be one of the BEST PLACES TO WORK not just here in Kern County, but throughout the Behavioral Healthcare Community.

By offering amazing benefits, encouraging individual growth and development, and incorporating our CARES values system into our daily operations, we are creating a workplace culture where...

The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.

• Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.
• Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.
• Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.
• Monitors all utilization reports to assure compliance with reporting and turnaround times.
• Addresses care issues with the Director of Clinical Services and Chief Medical...