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Utilization Review Specialist
2 months ago
We are seeking a highly skilled Utilization Review Specialist to join our team at Acadia Healthcare. As a Utilization Review Specialist, you will play a critical role in ensuring that our patients receive the highest quality care while also meeting the needs of our managed care partners.
Key Responsibilities- Collaborate with Managed Care Organizations: Act as a liaison between our organization and managed care partners to ensure seamless communication and coordination of care.
- Conduct Utilization Reviews: Conduct thorough reviews of insurance plans and managed care organizations to ensure compliance with certification requirements.
- Monitor Patient Length of Stay: Monitor patient length of stay and extensions, and inform clinical and medical staff of any issues that may impact length of stay.
- Develop Statistical and Narrative Reports: Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges, and quality of services.
- Conduct Quality Reviews: Conduct quality reviews for medical necessity and services provided.
- Facilitate Peer Review Calls: Facilitate peer review calls between our organization and external organizations.
- Initiate and Complete Appeals: Initiate and complete the formal appeal process for denied admissions or continued stay.
- Support Admissions Department: Assist the admissions department with pre-certifications of care.
- Provide Training and Support: Provide ongoing support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
- Education and Experience: LPN Diploma with a current NC Nursing license, or Associate's Degree in Nursing (RN) with current NC Nursing license, or Bachelor's Degree in Social Work, Behavioral Health, Mental Health, or other related healthcare field required.
- Certifications and Skills: CPR and CPI certification, teamwork, and excellent customer service.
- Master's Degree: Master's Degree in Social Work, Behavioral Health, Mental Health, or other healthcare-related field preferred.
- Current Licensure/Certification: Current NC clinical professional licensure/certification preferred.
- Experience: Two or more years' experience with the population of our facility and previous experience in utilization management preferred.
- Health Insurance: BC/BS Health Insurance (3 plans to choose from, eligible after 30 days of employment).
- Dental Insurance: Delta Dental (2 plans to choose from).
- Vision Insurance: NVA Vision Insurance.
- Life and AD&D Insurance: Paid life and AD&D insurance.
- 401k Plan: 401k with a matching contribution.
- Time Off: Vacation/Sick/Extended Sick, Personal/Holiday time.
- Disability Insurance: Short term and Long term disability.
- Employee Perks: Free onsite employee fitness center, free meals, employee discount program, employee fun events.
- Professional Development: Annual Performance Review and Merit Increase Review, salary increases for obtaining education degrees, professional certification, and/or licensure.
