UR Specialist: PRN

ESSENTIAL FUNCTIONS:

At Crestwyn Behavioral Health, you will have an opportunity to shine in your Utilization Review skills You will:

* 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.
* Facilitate peer review calls between facility and external organizations.
* Initiate and complete the formal appeal process for denied admissions or continued stay.
* Assist the admissions department with pre-certifications of care.
* Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

* Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

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

LICENSES/DESIGNATIONS/CERTIFICATIONS:

* Current clinical professional license or certification, as required, within the state where the facility provides services preferred.