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Utilization Review-Case Management (Full-Time)
Utilization Review-Case Management (Full-Time)Aurora San Diego • San Diego, CA, US
Utilization Review-Case Management (Full-Time)

Utilization Review-Case Management (Full-Time)

Aurora San Diego • San Diego, CA, US
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Work as a member of a multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers / third-party payers.

Pay Range : $32 / hr. to $60 / hr.

Work Schedule : Monday to Friday from 8 : 00 a.m. to 4 : 30 p.m.

Responsibilities :

  • Conduct admission reviews
  • Conduct concurrent and extended stay reviews
  • Prepare and submit appeals to third-party payers
  • Maintain appropriate records of the Utilization Review Department
  • Provide staff in-service training and education
  • Maintain confidentiality of patients at all times
  • Cope well with stress and possess a strong sense of compassion
  • Interact sensitively with persons of various social, cultural, economic, and educational backgrounds
  • Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
  • Strong organizational skills with the ability to prioritize projects, work independently, manage multiple tasks, and meet deadlines
  • Strong written and verbal communication skills
  • Strong interpersonal skills with the ability to work with people from diverse backgrounds
  • Work independently and as part of a team
  • Good judgment, problem-solving, and decision-making skills
  • Demonstrated commitment to collaborative work and leadership skills
  • Ability to work in a fast-paced, expanding organization

Skills :

  • Demonstrated knowledge of health care service delivery systems and third-party reimbursement
  • Two or more years of experience working in a managed care environment
  • Ability to apply and interpret admission and continued stay criteria
  • Strong understanding of admission and discharge functions
  • Familiarity with medical terminology, diagnostic terms, and treatment modalities
  • Knowledge of medical record-keeping requirements
  • Ability to comprehend psychiatric evaluations, consults, and lab results
  • Preferred Qualifications :

  • Current license as RN, LVN / LPT, LCSW
  • Master's degree in Social Work, Behavioral Science, or related field
  • Current BLS Certification for Healthcare Providers
  • Benefits :

  • 401K Retirement Plan
  • Health Insurance
  • Vision Insurance
  • Dental Insurance
  • Pet Insurance
  • Healthcare Spending Account & Dependent Care Spending Account
  • Life Insurance (Supplemental Life, Term, and Universal plans are also available)
  • PTO Plan with Holiday Premium Pay
  • PTO Cash Out option
  • Sick Pay
  • Short and Long-Term Disability (with additional buy-in opportunities)
  • Tuition Reimbursement
  • Employee Assistance Program
  • ID Theft Protection
  • J-18808-Ljbffr

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    Utilization Management • San Diego, CA, US

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