Healthcare Professionals (HCP) compliance with necessary vaccinations ensures the uninterrupted operational continuity of Oaklawn and leads by example in the health and safety of the community we serve. COVID-19 and Influenza are required vaccinations at Oaklawn, EEOC exemption requests will be considered. Please consider this before applying for positions.
Job Summary: Performs utilization review with external agencies to ensure payment for medically necessary inpatient services.
Essential Functions:
- Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives.
- Performs ongoing review of charts for inpatient psychiatric patients and partial hospitalization patients based on approved utilization review criteria.
- Refers utilization review issues to physician advisor and treatment team as appropriate.
- Appeals denied psychiatric days according to approved procedures.
- Maintains up-to-date information regarding requirements of individual insurance companies, and ensures these requirements are met.
- Participates in hospital utilization review committees as appropriate to psychiatric utilization review duties.
- Documents all communications and updates accordingly.
- Maintains stats regarding denied/uncovered days and length of stay.
- Delivers and tracks the Important Message from Medicare form.
- Acts as the court liaison.
- Assists as needed with phone intakes.
Minimum Qualifications: Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review. Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification.
Knowledge, Skills & Abilities: Master’s degree in Psychology preferred. Previous experience with utilization review, case management, or telephone triage desired. Familiarity with electronic medical records and medical terminology.
Working Conditions: Potential exposure to infectious disease.
Physical Requirements: Constantly sit, see/visual acuity, handle/grasp/feel, talk/hear, lift/carry 1 to 25 lbs. Frequently stand, walk, reach, bend/twist, lift/carry 25 to 49 lbs. Occasionally lift/carry 50+ lbs.
Marshall, 200 N Madison, Marshall, MI 49068
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