Utilization Review Specialist

3 weeks ago


North Kansas City, United States Acadia Healthcare Inc. Full time

Utilization Specialist Job Responsibilities:

* Act as liaison between managed care organizations and the facility professional clinical staff.
* Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
* Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
* Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
* Conduct quality reviews for medical necessity and services provided.

OTHER FUNCTIONS:

* Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

* Associate's degree in nursing (LPN or RN) required. Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field preferred.
* Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

* Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

Job Type: Full-time



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