Clinical Utilization Review Coordinator
2 weeks ago
KEY RESPONSIBILITIES:
Offer expert consultation and direction concerning patient admissions and the duration of stay to various insurance providers.
Obtain necessary authorizations from insurance entities for inpatient care and maintain ongoing authorization throughout the patient's treatment period.
Assess the utilization program to ensure adherence to relevant regulations, policies, and procedures.
Analyze clinical documentation from denied cases against established criteria to ascertain if the provided documentation supports the requested treatment.
Oversee staff management, which includes recruitment, professional development, training, performance evaluation, and effective communication to guarantee smooth departmental operations.
EDUCATIONAL BACKGROUND/EXPERIENCE/SKILL SET:
An associate's degree is mandatory. A bachelor's or master's degree in social work, behavioral or mental health, nursing, or a related health discipline is preferred.
A minimum of four years of clinical experience with the relevant patient population and prior experience in utilization management is essential.
Acadia Healthcare is an Equal Opportunity Employer, welcoming applications from Protected Veterans and Individuals with Disabilities.
The contractor will not terminate or discriminate against employees or applicants based on inquiries about, discussions of, or disclosures regarding their own pay or that of another employee or applicant.
However, employees with access to compensation information as part of their essential job functions are prohibited from disclosing the pay of other employees or applicants to individuals without access to such information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal obligations to provide information.
41 CFR c)-
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