Utilization Clinical Reviewer - Remote | WFH Job at Get It - Healthcare, Los Angeles, CA

dFk1ZFV3eU01eDVGcUR1YUtOdjZINUc3L2c9PQ==
  • Get It - Healthcare
  • Los Angeles, CA

Job Description

Job Summary
As a Utilization Clinical Reviewer, you will play an essential role in evaluating medical records to ensure the medical necessity of psychiatric inpatient care. By applying your clinical expertise, you'll assess whether services align with established guidelines, ensuring that individuals receive appropriate care. This position is crucial in maintaining the integrity of the Psychiatric Inpatient Concurrent Review process and follows regulatory standards such as those set by NCQA, URAC, and the California Mental Health Services Authority (CAMHSA).

This is a full-time, remote position open to residents of California with active licensure. It's an exciting opportunity to make a meaningful impact on healthcare without direct patient interaction.

Key Responsibilities

Medical Record Review: Review patient records to determine the medical necessity of care, ensuring documentation meets service requirements.
Decision-Making: Approve services or refer cases to physician consultants, providing clear and detailed rationales for any denials.
Data Documentation: Accurately document review-related data and submit necessary administrative paperwork in a timely manner.
Process Improvement: Identify opportunities to enhance review processes and collaborate with team members and stakeholders to implement improvements.
Collaboration and Communication: Serve as a liaison between internal and external stakeholders, building positive relationships and ensuring smooth communication throughout the review process.
Professional Development: Engage in ongoing training and meetings to stay current on updates relevant to the review process.
Compliance and Confidentiality: Uphold patient confidentiality by adhering to HIPAA policies and utilizing secure systems for data management.
Policy Adherence: Maintain professionalism and adhere to communication standards in all verbal and written interactions.
This is not an exhaustive list, and additional duties may be assigned as needed.

Required Qualifications and Experience

Experience: At least 2 years of experience working with Medicaid, government health plans, or hospital programs.
Licensure: Active California licensure as an LCSW, LMFT, LPCC, or LCPC.
Education: Master's degree from an accredited program in social work, counseling, or a related field.
Clinical Expertise: In-depth understanding of psychiatric disorders, Level of Care determination, and mental health assessments.
Regulatory Knowledge: Familiarity with Parity in Mental Health and Substance Use Disorder Services, as well as public sector service systems.
Technical Proficiency: Comfortable using Microsoft Office tools (Excel, Word, PowerPoint, Teams, Outlook) and web-based software.
Analytical Skills: Ability to evaluate psychological, emotional, behavioral, and physical functioning and provide evidence-based recommendations.
Detail-Oriented: Strong organizational skills, with the ability to prioritize and meet deadlines.
Medicaid Knowledge: Experience with Medicaid programs or similar government health systems.
Clinical Record Review: Ability to develop level-of-care recommendations based on clinical medical records and evaluations.
Why You Should Join Us
You'll be part of a dynamic team of healthcare professionals, where your work will directly impact lives across the country. We're committed to your growth and success, providing you with the resources, training, and support you need to thrive. If you're looking for meaningful work that makes a real difference in the lives of others, this is the place for you.

Our Commitment to You
We value your time and appreciate your interest in this position. Due to the high volume of applications, only those selected for further consideration will be contacted. We encourage you to apply for future opportunities that align with your skills and career goals.

Equal Opportunity Employer
We are an equal opportunity employer and value diversity in our workforce. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Benefits
We offer a comprehensive benefits package designed to support your health, well-being, and career. Our benefits include health plans, paid time off, retirement savings, wellness programs, educational assistance, corporate discounts, and more.

Compensation
The hourly compensation for this role ranges from $38.00 to $41.00.
Employment Type: Full-Time
Salary: $ 38.00 41.00 Per Hour

Job Tags

Hourly pay, Full time, Remote job,

Similar Jobs

Harvard University Health Services

Acupuncturist | Harvard University Health Services Job at Harvard University Health Services

Position Description Under the supervision of the Director of the Center for Wellness and Health Promotion, the Acupuncturist provides safe and effective acupuncture treatments according to intake assessment, diagnosis, and client needs. The Acupuncturist maintains client...

Johnston-Willis Hospital

Registered Nurse RN Mother Baby Job at Johnston-Willis Hospital

 ...patients deserve? At Johnston-Willis Hospital we support our colleagues in their positions. Join our Team as a Registered Nurse RN Mother Baby and access programs to assist with every stage of your career. * Full Time Night Shift * Benefits Johnston-Willis... 

NYU Langone Health

Senior Ambulatory Care Nurse - **Wound Center** Job at NYU Langone Health

 ...a place where our exceptionally talented faculty, staff, and students of all identities can...  ...our team as a Senior Ambulatory Care Nurse - **Wound Center**. In this role, the...  ...We require applications to be completed online. If you wish to view NYU Langone Health... 

Domino's

Delivery Driver(07894) - 15908 Halliburton Rd. Job at Domino's

Company Description Job Description ABOUT THE JOB Right now Domino's is looking for qualified drivers to staff stores in your area. We're growing so fast it's hard to keep up, and that means Domino's has lots of ways for you to grow (if that's what you want), ...

Little Discoveries

PreK Teacher Brockton Job at Little Discoveries

 ...Job Description: We are seeking a passionate and dedicated early childcare provider to join our team. As an early childcare...  ...school diploma or equivalent; relevant certifications or early childhood education degree is a plus. - Proven experience working with young children...