Utilization Specialist
2 days ago
The Utilization Specialist plays a critical role in ensuring the efficient use of healthcare resources at The Ranch at Dove Tree. This position is responsible for reviewing admissions, continued stays, and discharge planning to ensure that they meet approved clinically valid criteria.
Key Responsibilities- Conduct thorough reviews of patient admissions, continued stays, and discharge planning to ensure medical necessity and compliance with established criteria.
- Communicate effectively with insurance companies, health maintenance organizations (HMOs), and other payers to obtain approvals and resolve issues.
- Collaborate with physicians and other healthcare providers to ensure accurate and timely communication of patient information.
- Develop and maintain accurate documentation and files related to utilization management.
- Provide ongoing support and training to staff on documentation, charting requirements, and medical necessity updates.
- Identify and address potential payment problems by coordinating with the business office and clinical staff.
- Monitor client length of stay and extensions, and inform clinical and medical staff of issues that may impact length of stay.
- Participate in discharge planning and gather statistical and narrative information to report on utilization, non-certified days, and quality of services.
- Conduct quality reviews for medical necessity and services provided, and facilitate peer review calls between facility and external organizations.
- Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field.
- One or more years of direct clinical experience in a substance abuse setting and ASAM experience preferred.
The Ranch at Dove Tree offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. We are committed to serving Veterans and military spouses, and we recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
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