Department: Social Services
Job Code: 7-600
The Utilization Review Lead (UR Lead) is responsible for management of all utilization review/case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs. The UR Lead, along with the Clinical Director, over sees the UR Coordinators in the department and is there to help when asked. Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning. Coordinates information between third party payers and medical/clinical staff members. Interacts with members of the
medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered. All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and PI Standards.
Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred. At least two years psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
SKILLS AND KNOWLEDGE:
Must have excellent assertive communication skills and leadership skills. Knowledge and in-depth understanding of CD/psych treatment and discharge planning process. Must have good writing and composition skills. Must have good understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care. Must demonstrate strong patient advocacy skills. Must be able to organize and prioritize high volume workload. Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner. Must be able to function with minimal supervision. Therapeutic Intervention De-escalation Education required. Must have ability to maintain overall good work attitude and interact cooperatively and professionally with other staff members and third party payers to achieve mutually beneficial outcome. Must possess basic competency in age/disability/cultural diversity needs of patients served and ability to relate to patients in a manner sensitive to those needs.
CPR and CPI certified. State Certification.