Cost Center
163 Utilization Management
Scheduled Weekly Hours
0
Work Shift
Shift & Status
Who Are We?
We at Pine Rest believe in the power of healing and that everyone in our community has the right to expert care for mental health and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers who witness the impact of our life-changing work each day.
Each day, we are closing the gaps in access to care. We are innovating through leading-edge research, testing, programs, and treatment modalities that others replicate across the country. Our services include a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day programs), assessment and testing, residential, addiction treatment and specialty services such as crisis response, employee assistance programs, forensic psychiatry and psychology, and neuromodulation. On-the-job educational programs for nurses, psychologists, advanced practice providers, psychiatrists, and chaplains are equipping the next generation of care providers.
We are passionate about serving and are honored to be a part of this incredible work.
What Will You Do?
As a Utilization Management Clinician at Pine Rest, you’ll be part of tight-knit team that believes in the healing power of your expertise and compassion. This role manages all aspects of the certification for payment process. Completes admission authorization, out of network transfers, initiates concurrent authorization, completes retrospective authorizations and minimizes financial risk by maintaining timely communication with all payers.
Our Utilization Management Clinicians are driven to make an impact in the lives of those we serve and are motivated by the healing they witness first-hand each day. They are dedicated to excellent customer service, enthusiastic about the care we offer, and foster a sense of belonging and empowerment in a diverse workplace.
Who We Are:
We at Pine Rest believe in the power of healing and that everyone in our community has the right to expert care for mental health and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers who witness the impact of our life-changing work each day.
Each day, we are closing the gaps in access to care. We are innovating through leading-edge research, testing, programs, and treatment modalities that others replicate across the country. Our services include a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day programs), assessment and testing, residential, addiction treatment and specialty services such as crisis response, employee assistance programs, forensic psychiatry and psychology, and neuromodulation. Our on-the-job educational programs for nurses, psychologists, advanced practice providers, psychiatrists and chaplains are equipping the next generation of care providers.
We are passionate about serving and are honored to be a part of this incredible work.
Principal Duties and Responsibilities:
Organize and prioritize workload by contacting payers/authorizing agencies in a timely fashion in an effort to get hospital services approved.
Maintain a professional and collaborative relationship with the multi-disciplinary team to obtain information regarding severity of patients’ symptoms and intensity of services required for their care and to facilitate appropriate resource utilization in the provision of safe patient care.
Attests to and represents the clinical presentation of patients accurately according to the patient record while advocating for patients’ treatment needs with authorizing agencies and payers.
Obtaining pre-certification for admission and conducting concurrent reviews with third party payers.
Conducts reviews of Medicare admissions to assure stay meets criteria.
Remains current on all third party payer requirements for authorization of services and the appeals processes.
Works with the Pine Rest Contact Center to assure a smooth flow of admissions and maintains a good working relationship with the nursing units and physicians.
Anticipate patient's length of stay, treatment plans and outcomes based upon clinical knowledge, experience and length of stay guidelines.
Participate in discharge rounds/patient care conferences as indicated.
Responsible to role model the mission and values of the organization, presenting a professional image that is projected in appearance, attitudes and behaviors, time management and communication skills. Provides spiritual, emotional, social, mental and physical support to patients.
What Does This Role Require?
Education/Experience:
Must be an RN, LMSW, or LLP and possess or be eligible for a license in the State of Michigan.
Strong background in the provision of psychiatric services required, as well as excellent written and verbal communication skills.
Knowledge of medical terminology required.
Benefits:
Medical, dental, vision & life insurance plans
403(b) retirement match contribution by Pine Rest
Generous PTO for full and part time employees
Tuition assistance & loan forgiveness
Employee Assistance Program offering many free and discounted services for therapy, legal, accounting, gym membership, etc.
Partnership with Davenport University provides generous discount on tuition for employees and family members.
Notice:
Pine Rest provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
All new employees are subject to a criminal background check and education verification which may include sending a copy of your high school diploma, GED, or college transcripts.
Successful completion of a drug screen prior to employment is also part of our background process.