Utilization Review/Case Management Nurse Or Clinician (Lvn, Lpt, RN, Msw, Mft)

Aurora Santa Rosa Hospital Santa Rosa , CA 95401

Posted 3 weeks ago

POSITION TITLE: Utilization Review/Case Management Nurse or Clinician

REPORTS TO (TITLE): Director of Utilization Review


Work as a member of a multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third-party payers.


  • Admissions: Conduct admission reviews.
  • Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews.
  • Payment Appeals: Prepare and submit appeals to third-party payers.
  • Recordkeeping: Maintains appropriate records of the Utilization Review Department.
  • Training: Provide staff in-service training and education.
  • Maintains confidentiality of patients at all times.
  • Ability to cope well with stress and have a strong sense of compassion.
  • Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.
  • Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint.)
  • Strong organizational skills with the ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
  • Strong written and verbal communication skills.
  • Strong interpersonal skills. Ability to work with people with a variety of backgrounds and educational levels.
  • Ability to work independently and as part of a team.
  • Good judgment, problem-solving, and decision-making skills.
  • Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
  • Ability to work in a fast-paced, expanding organization.

POSITION Requirements:


  • Current license as an LCSW, ASW, MFTi, LMFT, LVN, LPT or
  • Preferred; Masters degree in Social Work, Behavioral Science, or related field otherwise BA in Psychology or counseling with at least one year experience working in Behavioral Health.
  • Current CPR certification.
  • NCI (or equivalent) preferred but not required.

Knowledge and Experience:

  • Demonstrated knowledge of health care service delivery systems and third party reimbursement
  • Two or more years experience working in a managed care environment
  • Ability to apply and interpret admission and continued stay criteria
  • Strong understanding of admission and discharge function
  • Familiarity with medical terminology, diagnostic terms and treatment modalities
  • Knowledge of medical record-keeping requirements
  • Ability to comprehend psychiatric evaluations, consults, and lab results



  • Current license as an LCSW, ASW, MFTi, LMFT, LVN, LPT or
  • Preferred; Masters degree in Social Work, Behavioral Science, or related field otherwise BA in Psychology or counseling with at least one year experience working in Behavioral Health.
  • Current CPR certification.
  • NCI (or equivalent) preferred but not required.


Full-time position with full-time benefits

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Utilization Review/Case Management Nurse Or Clinician (Lvn, Lpt, RN, Msw, Mft)

Aurora Santa Rosa Hospital