Bayside Marin Treatment Center
Utilization Review Specialist
Bayside Marin Treatment Center, San Rafael, California, United States, 94911
Overview
Purpose Statement: The Utilization Review Specialist proactively monitor utilization of services for patients to optimize reimbursement for the facility. You will assess patient care plans to ensure appropriate and cost-effective treatment, advocating for quality care while managing healthcare resources. Salary and Hours: Salary: $64,713 - $75,248 /Yr. | Hours: 8pm - 5pm (Monday - Friday) About Us
At Bayside Marin drug and alcohol addiction treatment center, we take pride in the expertise and dedication of our staff. Our therapists and counselors are carefully selected for skill, passion, and clinical excellence. Our staff is knowledgeable about recovery, with many years of personal recovery. We respond to diverse client challenges with a dedicated team that tailors treatment plans to address specific challenges to long-term recovery. We treat people, not just diagnoses, recognizing each client’s unique needs, backgrounds, and beliefs. 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. Additional Regulatory 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. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws. AHMKT Seniority level
Entry level Employment type
Full-time Job function
Other Industries
Mental Health Care
#J-18808-Ljbffr
Purpose Statement: The Utilization Review Specialist proactively monitor utilization of services for patients to optimize reimbursement for the facility. You will assess patient care plans to ensure appropriate and cost-effective treatment, advocating for quality care while managing healthcare resources. Salary and Hours: Salary: $64,713 - $75,248 /Yr. | Hours: 8pm - 5pm (Monday - Friday) About Us
At Bayside Marin drug and alcohol addiction treatment center, we take pride in the expertise and dedication of our staff. Our therapists and counselors are carefully selected for skill, passion, and clinical excellence. Our staff is knowledgeable about recovery, with many years of personal recovery. We respond to diverse client challenges with a dedicated team that tailors treatment plans to address specific challenges to long-term recovery. We treat people, not just diagnoses, recognizing each client’s unique needs, backgrounds, and beliefs. 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. Additional Regulatory 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. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws. AHMKT Seniority level
Entry level Employment type
Full-time Job function
Other Industries
Mental Health Care
#J-18808-Ljbffr