Responsible for management, coordination and documentation of utilization and external review activities to ensure an active and effective utilization management program. All duties are performed in accordance with the utilization review plan, Federal and State rules, regulations and guidelines, as well as JCAHO standards. In collaboration with members of the Shands at Vista clinical teams, is responsible for the coordination of resource utilization management and for patient/family education regarding resource allocation decision-making.
Position Minimum Requirements
Masters degree in social work (MSW) or other related clinical field from accredited university required.
Must possess strong written and verbal communication skills. Is able to negotiate and manage challenging situations diplomatically. Ability to weigh the patient’s medical and psychosocial-emotional needs against criteria to assist the clinical team in determining most appropriate use of resources. Ability to use a computer required. Post graduate experience in behavioral health preferred. Experience performing utilization review in a hospital setting, for a third party payor or other review agency or organization preferred. Knowledge of Federal and State guidelines, peer review organizations and other payor groups preferred.