Utilization Review Specialist Full-timeAcadia Healthcare • Riverside, CA, USA

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Utilization Review Specialist Full-time

Acadia Healthcare • Riverside, CA, USA

30+ days ago

Job type

Full-time

Job description

Our Full-time benefit package offers the following benefits :

Competitive Salary
Paid Time Off
Paid Holidays (8 Total)
Medical, Dental, & Vision Insurance
FSA & HSA Plans
Long-Term & Short-Term Disability
Company Paid Life Insurance
Supplemental Life Insurance
Employee Assistance Program
Employee Discount Program
401(k) Retirement Plan with Company Match
Many employee-centered events throughout the year!

Hourly pay range : $31-50 Dependent on candidate's current licensure and experience.

The desired schedule for this position is 530AM to 2PM Monday through Friday.

PURPOSE STATEMENT :

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

ESSENTIAL FUNCTIONS :

Act as liaison between managed care organizations and the facility professional clinical staff.

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) 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 (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.

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.

OTHER FUNCTIONS :

Perform other functions and tasks as assigned.

EDUCATION / EXPERIENCE / SKILL REQUIREMENTS :

Required Education : High school diploma or equivalent.

Preferred Education : Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.

Experience : Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.

LICENSES / DESIGNATIONS / CERTIFICATIONS :

Preferred Licensure : LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.

First aid may be required based on state or facility requirements.

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Utilization Review Specialist • Riverside, CA, USA

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