Position title
Utilization Review
Description

PURSUE YOUR PASSION, Not Just Another Job!

Veterans Village of San Diego is looking for employees who are passionate about serving all veterans. Changing the life of a vet takes a whole lot of work. It also takes dedication and commitment to our motto: Leave No One Behind. But the rewards are out of this world! We work hard, but we also enjoy having fun together. If you wish to be a part of this team and are ready to work for a cause, not just a paycheck, then VVSD is the place to start!

The Utilization Review Specialist is responsible for the managing the utilization review deadlines for the program and ensuring all documents are submitted in a timely manner. Responsible for all Client Utilization reviews through the client’s continued stay and assist in discharge planning activities under the direction of the Program Director.

If you are committed to positive outcomes for our veterans, this is the position for you!

 

Essential Duties and Responsibilities
  • Reviews client files to ensure all required documents are included and in compliance for submission to Optum for client’s authorization in the program.
  • Ensures the most updated and correct documents are being used in the program and submitted in a timely manner.
  • Knowledge of Medical Necessity criteria to effectively communicate plans of care to Optum and program staff.
  • Collaborates with the Medical Director and all members of the multidisciplinary team to facilitate utilization management activities and facilitates the following on a timely basis:
    • Tracking authorization deadlines and communicating with program staff of all requirements;
    • Reviewing authorization documents for completeness and compliance;
    • Submitting authorization documents to Optum within the required timelines;
    • Communicating with necessary program staff on authorization updates for clients;
    • Entering updated authorization information in required databases (i.e. SanWITS, Clarity, Apricot);
    • Provides assistance and appropriate referrals to outlying facilities and other alternate care services in collaboration with program staff.
  • Assist in billing accuracy and data entry in the appropriate databases.
  • Assist in the review of client files for accuracy and compliance.
  • Other duties as assigned by supervisor
Qualifications
  • Bachelor’s in Behavioral/Mental Health Field preferred, or related experience
  • A minimum of two years of experience working with the Utilization Review process is preferred.
  • Experience in Behavioral Health Care and knowledge of the ASAM criteria is preferred
  • Knowledge of analyzing data and submitting reports to meet deadlines
  • Must be organized and able to multi-task
  • Excellent professional phone skills
  • Experience maintaining files and records both computerized and hard copy
  • Ability to fluently read, write and communicate in English
  • Must be able to prioritize and switch priorities at a moment’s notice
  • Able to effectively interact, in a professional manner, with a variety of government agencies, state, county, city, and federal
  • Ability to comfortably, both mentally and physically, perform all aspects of job description and other duties as assigned by supervisor
  • Must have privately owned vehicle, current driver’s license and proof of current vehicle insurance
  • Ability to work with a diverse population
  • Negative TB test annually; bi-annually if Chest X-Ray test is required
  • CPR/First Aid training bi-annually.
  • Veteran Status a Plus!

 

Physical Requirements:

  • Ability to bend and lift light objects
  • Ability to sit for extended periods of time while viewing a computer monitor
  • Dexterity of hands and fingers to operate a computer keyboard
  • Capable of hearing and speaking to exchange information
  • Seeing to read reports and data
  • Must be able to work in a noisy, busy environment.

 

 

Job Benefits

VVSD offers competitive pay and benefits including 12 paid holidays a year, paid vacation and paid sick leave, pension, health insurance, dental and vision plans.

Please Note:
• • If you were a client of VVSD, you must have been out of all programs for a minimum of 2 years.
• • Veterans Village of San Diego is an equal opportunity workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Employment Type
Full-time
Job Location
Date posted
September 21, 2021
PDF Export
Apply

Send your Resumes and Cover Letter to hr@vvsd.net

Close modal window

Position: Utilization Review

Thank you for submitting your application. We will contact you shortly!