Utilization Reviewer

Trauma Informed Psychiatric Residential Treatment Facility for adolescents seeks a Utilization Reviewer to complete all aspects of the Utilization Review (UR) process. The position will ensure that all resident records are in compliance with Medicaid and other insurance provider requirements in order to receive reimbursement for services provided. This position ensures that services are provided at the appropriate level of care and in a timely manner as dictated by managed care organizations, insurance carriers, applicable licensing entities, and relevant accrediting bodies. The Utilization Reviewer gathers appropriate clinical documentation to provide third party payers, including managed care organizations, with the documentation needed to obtain pre-approval and continued stay authorizations. The Utilization Reviewer is responsible for staying up to date with any regulatory changes related to documentation and treatment compliance and educates staff on these requirements. The Utilization Reviewer performs medical record reviews and chart audits to ensure compliance with Medicaid, Department of Behavioral Health & Developmental Services, accreditation, and organization requirements. The Utilization Reviewer will submit initial and continued stay reviews to the managed care organization for approval.

Licensed RN or LPN preferred. Bachelor’s degree in nursing, social work, psychology, mental health, medical or related field preferred.

Two years’ experience in utilization management with a psychiatric treatment facility is preferred. Two years clinical experience in an inpatient setting preferred. Experience working with electronic medical records is required. Knowledge of trauma informed behavioral health treatment modalities is required. Excellent verbal and written communications skills are required. Proficiency in Microsoft Word, Outlook, and Internet Explorer with the ability to navigate a Windows environment required. The ability to efficiently operate an electronic medical records platform is required.

Competitive pay & benefits including company sponsored 401(k) plan, health, life, dental, and vision insurance. JFBHS is a Drug Free Work Place. Position Open until filled. EOE.

E-mail or fax cover letter and resume to:

Jackson-Feild Behavioral Health Services

Attn: Chris Thompson

Job#: 2022-11

E-mail: careers@jacksonfeild.org

Fax: (833) 418-1986