Utilization Review Specialist I

About the role

The Utilization Review Specialist will review clinical documentation to screen for appropriateness of admission, continued stay criteria, and special studies regarding delivery of care, treatment, and services. They will coordinate the authorization and re-certification of services by external entities reimbursing the facility for care provided.

Responsibilities

• Review clinical documentation to ensure appropriateness of admission and treatment plans
• Screen for compliance with insurance and reimbursement guidelines
• Coordinate the authorization and re-certification of services from external entities
• Work closely with interdisciplinary teams to ensure continuity of care
• Ensure compliance with regulatory standards and policies

Requirements

• Bachelor’s degree or four years of technical clerical, administrative, secretarial, or general office work
• Experience in social work, psychology, or a psychiatric setting preferred
• Ability to pass an OSBI background check
• Valid driver’s license required for job-related travel

Qualifications

• High school diploma or equivalent
• Basic computer skills
• Strong attention to detail and organizational skills

Skills

• Proficient in Microsoft Office Suite
• Knowledge of healthcare regulations and reimbursement processes
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

Benefits

The State of Oklahoma offers a comprehensive benefits package including:

• Generous state-paid benefit allowance for insurance premiums
• A wide choice of health insurance plans with no pre-existing condition exclusions or limitations
• Flexible spending accounts for health care expenses or dependent care
• Employee assistance programs and health and fitness programs
• 11 paid holidays
• 15 days of vacation and 15 days of sick leave the first year
• Roth 401(k) retirement savings plan with a generous match
• Longevity bonus for years of service
• Student loan repayment options
• Training opportunities for continuing education units (CEUs)

Pay

The hourly rate for this position is $17.44.

Schedule

The primary working hours are 8:00am-4:30pm, Monday through Friday. The position requires coverage of 24 hours, 7 days per week, and work hours and location may vary depending on business necessity. Employees may be required to work weekends and overtime.