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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 optimizing our resources.
Key Responsibilities- Collaborate with Managed Care Organizations: Act as a liaison between managed care organizations and our facility's professional clinical staff to ensure seamless communication and coordination.
- Conduct Utilization Reviews: Conduct thorough reviews of insurance plans and other managed care organizations to ensure compliance with certification requirements and coordinate communication regarding reimbursement 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, as required by our facility leadership or corporate office.
- Conduct Quality Reviews: Conduct quality reviews for medical necessity and services provided to ensure compliance with our facility's standards.
- Facilitate Peer Review Calls: Facilitate peer review calls between our facility and external organizations to ensure collaboration and coordination.
- 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 to ensure timely and accurate processing.
- Provide Training and Support: Provide ongoing support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
- Education: 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.
- Experience: Two or more years' experience with the population of our facility and previous experience in utilization management preferred.
- Licenses/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.
Acadia Healthcare is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment that values diversity and promotes equal opportunities for all employees and applicants.
