Acadia Healthcare
Overview
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Utilization Review Specialist
role at
Acadia Healthcare . New Acute Psychiatric Hospital serving the desert communities is seeking an experienced individual to proactively monitor utilization of services for patients to optimize reimbursement for the facility. Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities
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. Education, Experience & Licensure
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. Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I Job Details
Job Type: Part-time Pay: $32.00 - $36.50 per hour Expected hours: 24 per week Expected Schedule: Saturday to Monday – 8:30 AM to 4:30 PM Benefits 401(k) with matching Employee assistance program Paid time off Professional development assistance Tuition reimbursement Equal Employment Opportunity
Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries
Mental Health Care
#J-18808-Ljbffr
Join to apply for the
Utilization Review Specialist
role at
Acadia Healthcare . New Acute Psychiatric Hospital serving the desert communities is seeking an experienced individual to proactively monitor utilization of services for patients to optimize reimbursement for the facility. Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities
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. Education, Experience & Licensure
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. Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I Job Details
Job Type: Part-time Pay: $32.00 - $36.50 per hour Expected hours: 24 per week Expected Schedule: Saturday to Monday – 8:30 AM to 4:30 PM Benefits 401(k) with matching Employee assistance program Paid time off Professional development assistance Tuition reimbursement Equal Employment Opportunity
Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries
Mental Health Care
#J-18808-Ljbffr