Qualifications

• Bachelor's Degree in Nursing, Psychology, or Social Work; Master's preferred.
• CA RN license required, with additional licenses in Social Work, AMFT, Mental Health Counseling preferred.
• 3-5 years of experience in acute inpatient psychiatric settings or utilization management.
• Strong knowledge of behavioral health managed care and clinical assessment aligned with DSM-V guidelines.
• Strong oral and written communication skills for patient advocacy and negotiations with payers.

Responsibilities

• Conduct daily clinical reviews for authorization of continued treatment with all payer types.
• Serve as a member of the multidisciplinary treatment team to guide on level of care and payer expectations.
• Prepare quality appeal and denial letters; support compliance with regulations through post claim recovery reviews.
• Collaborate with hospital operations to ensure documentation meets patient care standards.
• Analyze and contribute to monthly utilization data trends using hospital tools.
• Facilitate physician payer reviews as needed.
• Handle additional tasks as required by the position.

Benefits

• Opportunity to work in a multidisciplinary team environment.
• Access to ongoing professional development and training.
• Contributions to patient advocacy efforts within the psychiatric care setting.