UTILIZATION REVIEW (UR) CASE MANAGER - Pacific Shores Hospital (Oxnard, CA)
Company Description Facility Information:
Pacific Shores Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations and licensed by the State of California.
Job Description Job Description :
Utilization Review (UR) including assessment of medical records for appropriateness, level of care and severity of illness.
Assess utilization of treatment, modalities, medications, services and application of treatment protocols.
Coordinate and execute concurrent Utilization Review (UR) and Case Management throughout treatment.
Auditing of medical records to determine medical necessity / ongoing case management.
Understanding and execution of UR internal appeal processes, peer reviews and external appeal processes as needed.
Job Requirements:
1
yrs experience as an Psychiatric RN or Counselor 3
yrs experience Case Management 1
yrs UR experience in a Psychiatric Setting Active CA RN License # with no marks or stipulations or Licensed Counselor with Psych Exp Bachelor Degree required for applying counselors Inpatient and Outpatient Experience with Utilization Review (UR) and Case Management, behavioral health, eating disorders, coordination of care within a managed care environment is preferred.
Proficiency with insurance company websites and Microsoft Office programs Excellent Written and Oral Communication Skills Excellent Interpersonal, Organizational Skills Ability to meet deadlines in a high pressure, time sensitive environment Salaries and
Benefits:
Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Pacific Shores Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations and licensed by the State of California.
Job Description Job Description :
Utilization Review (UR) including assessment of medical records for appropriateness, level of care and severity of illness.
Assess utilization of treatment, modalities, medications, services and application of treatment protocols.
Coordinate and execute concurrent Utilization Review (UR) and Case Management throughout treatment.
Auditing of medical records to determine medical necessity / ongoing case management.
Understanding and execution of UR internal appeal processes, peer reviews and external appeal processes as needed.
Job Requirements:
1
yrs experience as an Psychiatric RN or Counselor 3
yrs experience Case Management 1
yrs UR experience in a Psychiatric Setting Active CA RN License # with no marks or stipulations or Licensed Counselor with Psych Exp Bachelor Degree required for applying counselors Inpatient and Outpatient Experience with Utilization Review (UR) and Case Management, behavioral health, eating disorders, coordination of care within a managed care environment is preferred.
Proficiency with insurance company websites and Microsoft Office programs Excellent Written and Oral Communication Skills Excellent Interpersonal, Organizational Skills Ability to meet deadlines in a high pressure, time sensitive environment Salaries and
Benefits:
Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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