COORD - CASE MGMT/UTILIZ REV

Utilization Review Coordinator- Psychiatric Unit *BONUS * at Corona Regional Rehabilitation Hospital in Corona, CA

This a full-time, day shift position working from Monday-Friday 8:00 am - 4:30 pm

The (LVN/LPT) Utilization Review Coordinator in our Psychiatric Unit will be reporting to the Social Services Supervisor and Director of Behavioral Health Services, this position assures oversight and coordination of utilization review activities proactively monitoring documentation and reimbursement for services provided in the inpatient acute psychiatric unit. The Utilization Review Coordinator reviews medical records of patients admitted for psychiatric/mental illness to ensure proper utilization of facility resources, conducts review of patient records to ensure proper case documentation and medical necessity of treatment in accordance with Federal, State, and County regulations; assesses continuing treatment plans and advocates for required patient treatment with medical providers.

The tradition of caring that culminated in the establishment of Corona Regional Medical Center began in 1965, with the founding of Corona Community Hospital. Since that time the hospital has changed to meet the needs of the rapidly growing community. Corona Community Hospital merged with Circle City Medical Center in 1992 and the resulting entity became Corona Regional Medical Center. The merged hospitals are now a 238-bed community hospital network comprised of a 160-bed acute care hospital and a 78-bed rehabilitation campus. It is certified by The Joint Commission, employs more than 1,250 trained healthcare workers and has a medical staff of approximately 347 physicians representing more than 40 specialties.

ESSENTIAL KNOWLEDGE / SKILLS

Familiar with the Healthcare Delivery System, Medicare and Medi-Cal reimbursement guidelines; knowledgeable of applicable State,
Federal and 3rd party regulations/standards required
Knowledgeable and experienced with the appeal process
Excellent verbal and written skills; assertive, persistent and persuasiveness
Understanding of admission and discharge criteria
Familiarity with medical terminology, treatment modalities and diagnostic terminology
Flexible, maintains attention to detail and responsiveness to deadlines
Strong interpersonal, organizational and time management skills, requiring minimal supervision
Strong computer skills required

MINIMUM ESSENTIAL EXPERIENCE

Significant Utilization Review experience required, minimally one year.

MINIMUM ESSENTIAL EDUCATION

Assaultive behavior management training (MAB) required within 90 days of hire

REQUIRED LICENSURE / CERTIFICATIONS

Current Californica License LVN/LPT
Current CPR Certificate from the American Heart Association

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We believe that diversity and inclusion among our teammates is critical to our success.

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