Behavioral Health Social Worker, Utilization Review, Days (onsite)

Social Worker-Utilization ReviewJoin Palestine Regional Medical Center in Palestine, TX, a 150-bed hospital that has recently earned the prestigious Leapfrog "A" Safety Grade, the Platinum Award for quality from parent-company ScionHealth, and certification as a Chest Pain Center and Level IV Trauma facility. Palestine Regional provides a range of comprehensive care, including the latest in diagnostic, therapeutic, and rehabilitative services, both on an inpatient and outpatient basis. Palestine Regional is an integral part of the local community, giving you the chance to grow your career while making a real impact close to home.The Social Worker-Utilization Review monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, admissions, and extended stays.

The Social Worker-Utilization Review performs pre-certification, concurrent review, and discharge planning in accordance with applicable guidelines and acts as a liaison to support safe, timely, and medically necessary care.Essential FunctionsEnsures the medical necessity and appropriateness of all hospital admissions per established criteriaPerforms concurrent medical record reviews to justify continued stay and documents appropriatelyCoordinates with care team to facilitate timely and effective discharge planningCommunicates with third-party payers and managed care entities to provide required documentationCollaborates with social services and case management to streamline patient transitions and reduce readmissionsReviews and monitors patient charts in alignment with medical staff performance improvement metricsContributes to organizational quality goals and achieves performance targets in a timely mannerKnowledge/Skills/Abilities/ExpectationsStrong clinical assessment and critical thinking skillsAbility to interpret medical records, criteria, and regulationsKnowledge of utilization review processes, discharge planning, and payer requirementsProficient in communication and coordination with interdisciplinary teamsSkilled in documentation, confidentiality practices, and health information systemsDemonstrates resilience, adaptability, and the ability to manage stress effectivelyFrequent use of computers and telephoneMust be able to sit or stand for prolonged periodsOccasional lifting of up to 25 poundsFrequent walking and light movement required during audits or roundingHospital setting with exposure to general healthcare conditionsMay involve contact with patients, families, and medical recordsPotential exposure to communicable diseases, bloodborne pathogens, and chemicalsFast-paced environment requires focus, accuracy, and confidentialityQualificationsEducationBachelor of Social Work degree from an accredited school of social work (Required) andMaster of Social Work degree from an accredited school of social work (Preferred)Licenses/CertificationsLicensed in the state of practice as LBSW, LMSW, or LCSW.License must be current and without restrictions.ExperienceTwo (2) years of progressive clinical experience preferred; psychiatric healthcare experience desirable