Utilization Reviewer Coordinator
Sutter Health - ‘Ewa Beach, HI

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Located on 14.5 acre campus, Kahi Mohala's 88-bed facility is Hawaii's only private, freestanding psychiatric hospital and center for psychiatry. Kahi Mohala provides comprehensive behavioral health services for adults, adolescents and children experiencing problems with psychiatric disorders, alcohol and drug abuse, anxiety, depression, eating disorders, emotional disturbances and work of family relationship challenges.

Under the general supervision of the Clinical Support Service manager, coordinates all aspects of Utilization Management, working closely with Admissions, Administration, Patient Financial Services, Medical Staff, Social Work, Nursing, Marketing, and Outpatient Services. Serves as a clinical resource to the Risk Manager in the identification and investigation of potential claims and occurrence reports. The Utilization Coordinator will personally manage all appeals. Provides education to physicians and nurses on elements of documentation to support authorizations at least annually. This incumbent will also perform special projects as assigned.

Qualifications

Graduate of accredited RN program; current Hawaii RN license required. BSN with managed care experience preferred. Seasoned inpatient psychiatric experience. Managed care/utilization review and quality assurance experience required.

Knowledge of utilization management review guidelines and regulations, familiarization with JCAHO standards, knowledge of state regulations, familiarity with Managed Care standards. Knowledge of community standards, case management, knowledge of performance improvement standards and its relationship to risk management.

Effective verbal communication, excellent telephone skills/etiquette. Must be computer literate, able to prioritize, delegate and problem solve.

Certification in Utilization Review valued and encouraged.

Primary Location

:

Hawaii-Oahu-Ewa Beach

Other Locations

:

Hawaii-Oahu-Ewa Beach

Organization

:

Kahi Mohala Hospital, Hawaii

Employee Status

:

Regular

Accepted Applications

:

All Candidate Applications Accepted

Union

:

No

Job Shift

:

Day

Shift Hours

-

8 Hour Shift

Shift Start Time

:

0730

Schedule

:

Call-In

Hours Per 2wk Pay Period

:

Varied

Sutter Health - 22 months ago - save job - block
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