Social Worker - Utilization Review
📋 Role Overview & Responsibilities
Job Title: Social Worker - Utilization Review Location: Temecula, CADuration: 3 Months (Possible extension)Shift: DAYS - 8 HR: 9a - 5:30p
Summary:The Utilization Review Social Worker plays a crucial role in healthcare settings, ensuring that patients receive appropriate and effective care while managing costs and resources efficiently.They work closely with medical teams, insurance providers, and patients to assess treatment plans, evaluate progress, and advocate for optimal care outcomes.
Required:Master's degree in Social Work (MSW) from an accredited institution.State licensure required.Minimum of 2 years of experience in Acute Hospital settings.
Responsibilities:Utilization Review: Conduct comprehensive reviews of patient medical records, treatment plans, and insurance coverage to determine the appropriateness and necessity of healthcare services.Assessment and Evaluation: Evaluate patients' mental, emotional, and social needs to understand their unique circumstances and recommend suitable treatment options.Treatment Planning: Collaborate with healthcare providers to develop and implement individualized treatment plans that address patients' clinical needs while considering resource utilization and cost-effectiveness.Advocacy: Serve as an advocate for patients, ensuring they receive timely access to necessary services and interventions. Advocate for appropriate levels of care and support services based on patients' clinical and social needs.Documentation and Reporting: Maintain accurate and detailed documentation of patient assessments, treatment plans, and utilization review activities. Generate reports summarizing findings and recommendations for stakeholders.Compliance: Ensure compliance with regulatory requirements, healthcare policies, and insurance guidelines related to utilization review and patient care.Communication: Facilitate communication between healthcare providers, insurance companies, and patients to coordinate care, address concerns, and resolve issues related to treatment plans and coverage.Continuous Improvement: Stay informed about advancements in healthcare practices, treatment modalities, and insurance regulations. Participate in training and professional development activities to enhance knowledge and skills relevant to utilization review and social work practice.
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This position is located in Temecula, CA with potential relocation and sponsorship assistance depending on candidate qualifications.
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