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Healthcare Utilization Manager
2 months ago
We are seeking a highly skilled Clinical Utilization Specialist to join our team at Acadia Healthcare. As a Clinical Utilization Specialist, you will play a critical role in ensuring the efficient and effective use of healthcare resources.
Key Responsibilities- Liaison Role: Act as a liaison between managed care organizations and our facility's professional clinical staff to facilitate communication and ensure reimbursement requirements are met.
- Review and Coordination: Conduct reviews of insurance plans and managed care organizations, and coordinate the flow of communication concerning reimbursement requirements.
- Length of Stay Monitoring: Monitor patient length of stay and extensions, and inform clinical and medical staff on issues that may impact length of stay.
- Statistical and Narrative Reporting: Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges, and quality of services, as required by our facility leadership or corporate office.
- Quality Reviews: Conduct quality reviews for medical necessity and services provided.
- Peer Review Calls: Facilitate peer review calls between our facility and external organizations.
- Appeal Process: Initiate and complete the formal appeal process for denied admissions or continued stay.
- Pre-Certifications: Assist the admissions department with pre-certifications of care.
- Staff Support and Training: Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria, and medical necessity updates.
- Education and Experience: LPC or LSW in behavioral or mental health or other related health field will be considered. Two or more years' experience with the population of our facility and previous experience in utilization management preferred.
- Licenses and Certifications: Current licensure as an LPN or RN within the state where our facility provides services; or current clinical professional license or certification, as required, within the state where our facility provides services. CPR and de-escalation and restraint certification required (training available upon hire and offered by our facility). First aid may be required based on state or facility requirements.
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances dictate.
