River Place Behavioral Health Hospital
Utilization Review Specialist- Full Time
River Place Behavioral Health Hospital, Laplace, Louisiana, United States, 70000
Utilization Review Specialist – Full Time
River Place Behavioral Health Hospital
Join to apply for the Utilization Review Specialist – Full Time role at River Place Behavioral Health Hospital.
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 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 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 that state.
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.
Seniority Level Entry level
Employment Type Full-time
Job Function Other
Industries Mental Health Care
#J-18808-Ljbffr
Join to apply for the Utilization Review Specialist – Full Time role at River Place Behavioral Health Hospital.
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 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 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 that state.
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.
Seniority Level Entry level
Employment Type Full-time
Job Function Other
Industries Mental Health Care
#J-18808-Ljbffr