Utilization Specialist
5 days ago
Ascension St. Thomas Behavioral Health Hospital is seeking a skilled Utilization Specialist to join our team. As a Utilization Specialist, you will play a critical role in optimizing reimbursement for our facility and ensuring the highest quality of care for our patients.
Key Responsibilities- Monitor patient length of stay and extensions, and inform clinical and medical staff on issues that may impact length of stay.
- Conduct reviews of insurance plans and coordinate communication with managed care organizations to ensure reimbursement requirements are met.
- 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.
- Facilitate peer review calls between 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.
- High school diploma or equivalent required; Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field preferred.
- Clinical experience required; two or more years' experience working with the facility's population preferred.
- Previous experience in utilization management highly preferred.
- LPN, RN, LMSW, LCSW, LPC, LPC-I licensure or current clinical professional license or certification required within the state where the facility provides services.
- CPR and de-escalation and restraint certification required; first aid may be required based on state or facility requirements.
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Utilization Specialist
2 days ago
Nashville, Tennessee, United States Ascension St. Thomas Behavioral Health Hospital Full timeJob SummaryWe are seeking a highly skilled Utilization Specialist to join our team at Ascension St. Thomas Behavioral Health Hospital. The successful candidate will be responsible for proactively monitoring the utilization of services for patients to optimize reimbursement for the facility.Key ResponsibilitiesAct as a liaison between managed care...
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Clinical Utilization Specialist
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Nashville, Tennessee, United States Newport Healthcare Full timeAbout the RoleNewport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. We are seeking a skilled Clinical Utilization Specialist to join our team, responsible for managing an active caseload of clients and ensuring seamless communication with insurance companies,...
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Utility Operations Specialist
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Technical Support Specialist
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Technical Support Specialist
2 weeks ago
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Customer Support Specialist
1 week ago
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