Social Worker-Utilization Review

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

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 Functions

• Ensures the medical necessity and appropriateness of all hospital admissions per established criteria
• Performs concurrent medical record reviews to justify continued stay and documents appropriately
• Coordinates with care team to facilitate timely and effective discharge planning
• Communicates with third-party payers and managed care entities to provide required documentation
• Collaborates with social services and case management to streamline patient transitions and reduce readmissions
• Reviews and monitors patient charts in alignment with medical staff performance improvement metrics
• Contributes to organizational quality goals and achieves performance targets in a timely manner

Knowledge/Skills/Abilities/Expectations

• Strong clinical assessment and critical thinking skills
• Ability to interpret medical records, criteria, and regulations
• Knowledge of utilization review processes, discharge planning, and payer requirements
• Proficient in communication and coordination with interdisciplinary teams
• Skilled in documentation, confidentiality practices, and health information systems
• Demonstrates resilience, adaptability, and the ability to manage stress effectively
• Frequent use of computers and telephone
• Must be able to sit or stand for prolonged periods
• Occasional lifting of up to 25 pounds
• Frequent walking and light movement required during audits or rounding
• Hospital setting with exposure to general healthcare conditions
• May involve contact with patients, families, and medical records
• Potential exposure to communicable diseases, bloodborne pathogens, and chemicals
• Fast-paced environment requires focus, accuracy, and confidentiality

Education

• Bachelor of Social Work degree from an accredited school of social work (Required) and
• Master of Social Work degree from an accredited school of social work (Preferred)

Licenses/Certifications

• Licensed in the state of practice as LBSW, LMSW, or LCSW.
• License must be current and without restrictions.

Experience

• Two (2) years of progressive clinical experience preferred; psychiatric healthcare experience desirable