(Archived) Rainier Springs Utilization Review Specialist (FT)

Overview

GREAT OPPORTUNITY in Vancouver, WA

Behavioral Health Clinical Review Specialist (Utilization Review)

Rainier Springs is a 72-bed behavioral hospital located in Vancouver, Washington. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Rainier Springs we are dedicated to Changing People’s Lives®.

The Utilization Review department (UR) plays an essential role in helping fulfill our mission of “Changing People’s Lives®”. Utilization Review Specialist facilitates clinical pertinence reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. UR chairs the treatment team meetings and continues stay reviews as directed by manager.

Members of our team Enjoy:

• Working with a highly engaged staff
• Healthy staffing levels
• Flexible scheduling
• Career growth
• Competitive compensation

• Daily Pay - We’ve partnered with DailyPay, a voluntary benefit to offer employees access to their pay on their own schedule

• Possesses knowledge of Clinical pertinence, managed care requirements for in and out patient authorization and advocates on behalf of the patient to secure insurance coverage for needed services.
• Completes pre-certifications and re-certifications for inpatient and outpatient services. Reports appropriate denial, length of stay and authorization information to designated resource.
• Actively communicates with interdisciplinary team to acquire information and give updates on authorizations.
• Monitors hospital length of stay and reports appropriately
• Participates in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with insurance companies/agencies
• Ensures appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews and other payers
• Communicate with physicians appropriately

Requirements:

• Bachelor’s degree or current clinical license required or license in lieu of degree.
• Current unencumbered clinical licensure and valid driver’s license
• CPR and CPI Certification within 30 day of employment

Experience:

• Previous utilization review experience in a psychiatric healthcare facility preferred