Job description

Our Team:

Sonora Behavioral Health, Tucson’s largest inpatient psychiatric hospital, is looking for talented and caring professionals to join our team! Sonora Behavioral Health offers competitive compensation, benefits and regular opportunities for development and advancement

The Utilization Specialistproactively monitors the utilization of services for patients to optimize reimbursement for the facility.

Essential Functions of the Utilization Specialist:

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Job Requirements:

• Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
• Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

Job Type: Full-time

Pay: From $23.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Medical specialties:

• Psychiatry

Physical setting:

• Hospital

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

COVID-19 considerations:
Full COVID precautions

Ability to commute/relocate:

• Tucson, AZ 85704: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Utilization review: 1 year (Required)

Work Location: In person

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