Utilization Reviewer (licensed required) – Bay Area

BHR is seeking a detailed oriented, professional and extremely organized Utilization Reviewer to oversee entire Medication Clinic utilization management process.


Status:  Part-time and per diem positions now available (no benefits)

- 20 hours per week (Monday – Friday)

      - Must be flexible and able to travel within the bay area

     

Starting Salary Range:
$22.00 per hour - $30.00 per hour depending on experience in Utilization Review, Auditing and Education

 

ABOUT BHR:
At BHR it is our mission to provide healthcare organizations with innovative healthcare systems that will enhance quality patient care, quickly identifying the needs of our customers, and utilizing resources more efficiently to remain competitive.

 
General Responsibilities:
The Utilization Reviewer in our medication clinics is responsible for overseeing utilization management matters as they relate to the management of the clinic medical records.  The goal is to assure compliance with clinic standards, policies and procedures for quality documentation and exceptional customer services.  Responsible for the operation and development of all UR issues in the clinics.  

 

 

1.                  Establish and maintain a regular presence in the clinical services of patients in order to continually assess their community and clinical needs.  This is done through providing brokerage and case management services in order to support the program.

2.                  Responsible for planning, organizing, development and evaluation of all Medication Clinic Utilization processes.

3.                  Insure that all medical records are in active treatment.

4.                  Conduct regular chart and client service audits.

5.                  Process and track all denied services.

6.                  Coordinate with billing and Quality Coordinator to ensure services billed are the services rendered.

7.                  Coordinate authorization of treatment for all patient services.

8.                  Coordinate Utilization Management documentation educational training for all staff at least 1x per quarter.

9.                  Coordinate Utilization Management site meetings and recordation of Utilization Management activity.

10.              Compile, complete and or update a written document that outlines the UR and Quality process.

11.              Perform other duties as assigned by Operations Management.

12.              Coordinate all quality improvement outcomes and regulatory compliance as it relates to medical records.



Minimum Qualifications

  • Registered Nurse (RN) with the State of California or Licensed MFT or LCSW Minimum of 3 years experience working with mentally ill population, in an inpatient or outpatient medical setting.
  • Or 3 years experience as a Utilization Reviewer in a healthcare setting.

            Experience must be in the area of clinical development, quality assurance,          

            utilization review, program development, service evaluation and or case

            management. 

  • Superior physician relations and communication skills.
  • Ability to lead and train various disciplines of staff.
  • Must have excellent written, oral skills and follow-up skills.
  • Must be flexible and able to work in a very fast pace work environment and able to work independently and with little direction.
  • Must be the “expert” in this area.

 

HOW TO APPLY:
Send the following (3) items to Resumes@bhrcorp.org  :

  1. Coverletter
  2. Resume
  3. Salary Requirements  

 

POSITION OPEN AS OF 4/4/11

To Apply online http://www.bhrcorp.org/sendapp.html . Please include salary requirement.

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