Mental Health Resource Center, Inc. · 1 month ago
Utilization Management Reviewer
Jacksonville, FL
Full-time
Onsite
Entry, Mid Level
1+ years expMental Health Resource Center is a not-for-profit organization that provides a wide range of mental health and behavioral health care services to the community. They are seeking a Utilization Management Reviewer to monitor the utilization of clinical services, review medical records, and participate in treatment team meetings.
Health CareMental HealthNon ProfitTherapeutics
Responsibilities
Reviews medical records and attends treatment team meetings to review utilization of resources and the level of care provided. Ensures utilization and level of care are appropriate based on the diagnosis, needs, age and culture of the individual
Carries out appropriate telephone and written communication with insurers and third party payers regarding referrals, admissions, medication changes, discharges and changes in level of care
Coordinates on-site review of medical records with reviewers from third party payers
Documents, updates, and manages patient and provider information using internal electronic records system
Coordinates psychiatric consultations between internal and external providers
Investigates complaints, grievances, and medication variances. Reports findings to Utilization Management Manager and completes necessary follow up
Responds to changing needs of the departments (i.e., program design, forms development, reporting mechanisms, etc).Establishes and maintains effective working relationships with staff members to assure professional interactions
Qualification
Required
Registered Nurse: Associate Degree in Nursing required
One year experience in psychiatric nursing required. Valid Florida RN License required
Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required
Two years experience in psychiatric nursing required. Valid Florida LPN License required
Master's degree in Psychology or Human Services related field required
Three years experience in the mental health field required
Excellent communication skills are essential and this individual must be able to interact appropriately with internal and external customers, including families, caregivers, community service providers, supervisory staff and other department professionals
Each employee contributes to the completeness and confidentiality of clinical records by ensuring documentation, paperwork and system entries meet internal and external guidelines for content, accuracy and timeliness
Preferred
UM experience preferred
Benefits
Dental insurance
Health insurance
Paid time off
Training & development
Vision insurance
Medical, Dental, and Vision Insurance
Life Insurance
Disability Insurance
403b
PTO
Paid Holidays
Flexible Spending Account
Employee Assistance Program
Company
Mental Health Resource Center, Inc.
MHRC provides a wide range of behavioral health services for adults, adolescents, children, and families.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase