Job Description:

1. Assists in the coordination of all aspects of concurrent review process for individual cases.
2. Coordinates readiness of clinical documentation for third-party payers and state agencies to secure timely payment for patient charges.
3. Participates in the utilization review and/or quality assurance programs.
4. Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation.

5. Work collaboratively with the treating providers
6. Reviews to determine appropriateness and medical necessity of admissions, continued stay and use of ancillary services.
7. Monitors third-party administrator and agency files to oversee contractor handling.
8. Performs data entry, which includes application of criteria sets and Diagnosis Review Groups (DRG) for the utilization review process.
9. Maintains a permanent record of all utilization review records, identifies problems, and follows through with resolutions.
10. Prepares reports and analyzes statistical data.
11. Other duties as assigned.

Experience:

- Master's degree in nursing from an accredited university.

- Three years experience in Psychiatric nursing.
- Proven experience in quality assurance or a related role.
- Strong knowledge of industry standards and regulations.
- Excellent analytical and problem-solving skills.
- Attention to detail and strong organizational skills.
- Effective communication and interpersonal skills.
- Proficient in using quality assurance tools and software.

Job Types: Full-time, Part-time

Benefits:

• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Psychiatry

Standard shift:

• Day shift

Weekly schedule:

• Monday to Friday

Work setting:

• In-person

Work Location: In person