UR Specialist

2 weeks ago

Statesboro, Georgia, United States Willingway Full time

Utilization Specialist

The Utilization Specialist plays a crucial role in reviewing assigned admissions, continued stays, utilization practices, and discharge planning based on approved clinically valid criteria. This helps in meeting daily deadlines for obtaining authorizations and completing other necessary processes.

Responsibilities include:

  • Conducting admission, concurrent, continued stay, and retrospective reviews utilizing established hospital criteria.
  • Collaborating effectively with insurance companies, HMOs, and similar entities to secure approval for treatment days.
  • Assisting the admissions department with pre-certifications of care and benefit verification.
  • Providing support and training to staff on documentation requirements and medical necessity updates.
  • Monitoring client length of stay, conducting quality reviews, and facilitating peer review calls.
  • Bachelor's degree in social work, behavioral or mental health preferred.
  • Encouragement for Veterans and military spouses to apply, with specialized programming available.

Job Type:
Full-time

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