Utilization Review Specialist

Job Description

Job Description

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 :

Job Type : Full-time, Non-Exempt

Work Schedule : Monday – Friday, 8 : 00 a.m. – 5 : 00 p.m.

Annual Salary : $38,500 ($18.50 per hour)

Posted until Filled

Minimum Qualifications and Experience :

Completion of a Bachelor’s Degree in social work, psychology, or related field from an accredited college or university plus one year of technical clerical, administrative, secretarial, or general office work.

Equivalent combination of education and experience is accepted.

Preferred : Experience in a mental health setting.

Special Requirements :

Valid driver’s license and the ability to travel as needed for job-related duties.

Must pass pre-employment and pre-placement drug and alcohol screening due to the safety-sensitive nature of this position.

Why Join Us?

Comprehensive Benefits : Generous base salary with a competitive benefits allowance

Health Coverage : Multiple insurance plan options, no pre-existing condition exclusions

Flexible Spending : Healthcare and dependent care FSA options

Time Off : 11 paid holidays

15 vacation days

15 sick days in the first year

Retirement Planning : Employer-matched retirement savings plan

Employee Support : Employee Assistance Program (EAP)

Longevity Pay : Bonuses for continued service

Professional Growth : Ongoing training opportunities and CEU support

About us :

Griffin Memorial Hospital (GMH) is the adult treatment center for the Oklahoma Department of Mental Health and Substance Abuse Services, serving all 77 counties across the state. 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 :

This facility operates 24 / 7. Work hours, shifts, and locations may vary based on operational needs.

Weekend and overtime work may be required.

Reasonable accommodation for individuals with disabilities is available upon request.

We are an Equal Opportunity Employer.

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