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Utilization Review Specialist
2 months ago
Acadia Healthcare is seeking a highly skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will serve as a liaison between managed care organizations and our facility's professional clinical staff.
Key Responsibilities- Conduct reviews of insurance plans and coordinate communication with 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, discharges, and quality of services.
- 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.
- 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.
- 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.
