Utilization Review Specialist

Utilization Review and Referral Specialists in the hospital setting are responsible for monitoring admissions for pre-certifications and compliance, conducting chart reviews, and consulting with internal and external providers regarding continued care or hospitalization
 
The ideal candidate will have experience in utilization management, and experience in an acute psychiatric setting.

• Monitors admissions to assure accurate pre-certification and compliance with hospital contract requirements is met.
• Conducts admission and concurrent chart reviews on all inpatient services to ensure criteria are being met for hospitalization.
• Obtains recertification as needed.
• Presents status updates on consumers addressing barriers to obtaining coverage for hospitalization. 
• Consults with internal providers and outside agencies regarding continued care or hospitalization.  
• Identifies and recommends opportunities for cost savings and improving the quality of care. 
• Provides linkage with guarantors and stays knowledgeable of current hospitalization criteria.
• Facilitates daily certification for hospitalization.
• Maintains accurate daily census statistics, monitors length of stay and coordinates financial follow up.
• Maintains accurate statistics of admissions, discharges, payer mix and revenues.
• Analyzes procedures and makes recommendations to improve efficiency.
• Adheres to professional code of ethics.
• Effectively demonstrates the application of child/adolescent and adult competencies.
• Seeks supervision and consultation as needed.
• Accepts and employs suggestions for improvement.
• Actively works to enhance assessment skills.
• Documents in a timely fashion per AltaPointe policy.
• Documents appropriate complete and comprehensive UR information.
• Documents discharges, follow-ups, and referrals.
• Documents legibly.
• Treats consumers with care, dignity and compassion.
• Respects consumers’ privacy and confidentiality.
• Is pleasant and cooperative with others.
• Assists consumers and visitors as needed.
• Personal values don’t inhibit ability to relate and care for others.
• Is sensitive to the consumers’ needs, expectations and individual differences.
• Is gentle and calm with consumers and families.
• Actively participates in Performance Improvement activities.
• Actively participates in AltaPointe committees as required.
• Completes assigned tasks in a timely manner.
• Accesses appropriate community resources according to consumer needs
• Follows AltaPointe policies and procedures.
• Maintains current license and requirements for renewals.
• Attends required in-service training and other workshops.

RN license to practice in the state of Alabama