Utilization Review Specialist

Utilization Review Specialist  About the Position :

• Under general direction of the Director of Operations, the Utilization Review (UR) Specialist helps to manage the facility’s utilization management processes.  This includes :   preparing of documentation necessary for the pre-certification of admissions and extensions of hospital stays for all patients; serving as liaison with gatekeepers, HMO’s, OHCA, and insurance companies; and maintaining spreadsheets and logs daily.    Elements to be included in data collection and analysis are; auditing of required medical record entries; inappropriate admissions; delays in services; delays in discharges; premature discharges; effectiveness of discharge planning; and over utilization and under utilization of resources.  When appropriate, will assist with coordination of transfers.
• This position will also contribute to the quality improvement process as well as compliance with JCAHO, Title XIX and other regulatory standards.  Will work closely with the Director of Operations and the medical, clinical and reimbursement staff to reduce the potential loss of collections.   The UR Specialist will participate in interdisciplinary treatment teams, clinical management meetings, agency meetings, and other duties as assigned.

This position is not remote and does require patient interaction.   Job Type / Salary :

Located in Norman, GMH specializes in crisis stabilization and residential treatment for individuals with substance abuse, mental health conditions, and trauma-related disorders.  Additional Information :