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Utilization Review Specialist PRN

2 months ago

Mesa, Arizona, United States Acadia Healthcare Full time
About the Role

We are seeking a highly skilled Utilization Review Specialist to join our team at Agave Ridge Behavioral Hospital, a leading provider of mental health services. As a Utilization Review Specialist, you will play a critical role in ensuring the efficient and effective delivery of care to our patients.

Key Responsibilities
  • Act as liaison between managed care organizations and our clinical staff to facilitate communication and ensure reimbursement requirements are met.
  • Conduct reviews of insurance plans 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, discharges, and quality of services.
  • Conduct quality reviews for medical necessity and services provided, and facilitate peer review calls between our 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.
What We Offer

We offer a competitive hourly rate, ranging from $29.00 to $37.00 per hour, depending on experience. Our benefits package includes a 401(k) retirement plan with company match, employee assistance program, and employee discount program. We are an Equal Employment Opportunity employer.