Anabranch Recovery Center
Utilization Review Specialist - Recovery
Anabranch Recovery Center, Terre Haute, Indiana, us, 47808
Utilization Review Specialist - Recovery
Anabranch Recovery Center – Terre Haute, Indiana
About the Job:
This is an ON SITE position in Terre Haute, IN. The Utilization Specialist reviews admissions, continued stays, utilization practices, and discharge planning according to approved clinically valid criteria, meeting daily deadlines for authorizations and other pertinent processes. Responsibilities include coordinating, performing, and monitoring all utilization review/management activities at the hospital to improve collection, reimbursement, coordination, and presentation of utilization review information, and educating hospital staff about requirements and trends.
Roles and Responsibilities
Perform admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria.
Communicate effectively with insurance companies, HMOs, and other entities for approval of initial or additional days for treatment, and provide concise technical information describing client’s condition and need for hospitalization.
Communicate directly with physicians and providers regarding utilization management inquiries and trends.
Appeal all denials, ensuring accuracy and coordination of correspondence; assist physicians in the appeals process.
Assist admissions department with pre-certifications of care and complete pre- and post-admission benefit verification with managed care organizations.
Maintain accurate documentation and files related to utilization management.
Provide ongoing support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
Communicate effectively with coworkers, program, and nursing staff regarding charting deficiencies and problems; follow up to ensure corrective action.
Coordinate information and findings with the business office to recognize or resolve potential payment problems.
Monitor client length of stay and extensions, informing clinical and medical staff of any issues that may impact length of stay; investigate short-term stays and develop alternate financial plans when appropriate.
Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges, and quality of services as required by leadership or corporate office.
Conduct quality reviews for medical necessity and services provided; facilitate peer review calls between the facility and external organizations; identify potential review problems and discuss with the multidisciplinary team or administration.
Act as liaison between managed care organizations and the facility’s professional clinical staff.
Assist with any problems encountered during on-site or telephone reviews by third-party payers or review organization.
Education, Experience & Skill Requirements
High School diploma or equivalent required; graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field preferred.
One or more years of direct clinical experience in a substance abuse setting required; ASAM experience preferred.
At least one year of experience in utilization review preferred.
Why Anabranch Recovery Center? The center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume.
Anabranch Recovery Center is an Equal Opportunity Employer. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country, recognizing and valuing the unique strengths of the military community.
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About the Job:
This is an ON SITE position in Terre Haute, IN. The Utilization Specialist reviews admissions, continued stays, utilization practices, and discharge planning according to approved clinically valid criteria, meeting daily deadlines for authorizations and other pertinent processes. Responsibilities include coordinating, performing, and monitoring all utilization review/management activities at the hospital to improve collection, reimbursement, coordination, and presentation of utilization review information, and educating hospital staff about requirements and trends.
Roles and Responsibilities
Perform admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria.
Communicate effectively with insurance companies, HMOs, and other entities for approval of initial or additional days for treatment, and provide concise technical information describing client’s condition and need for hospitalization.
Communicate directly with physicians and providers regarding utilization management inquiries and trends.
Appeal all denials, ensuring accuracy and coordination of correspondence; assist physicians in the appeals process.
Assist admissions department with pre-certifications of care and complete pre- and post-admission benefit verification with managed care organizations.
Maintain accurate documentation and files related to utilization management.
Provide ongoing support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
Communicate effectively with coworkers, program, and nursing staff regarding charting deficiencies and problems; follow up to ensure corrective action.
Coordinate information and findings with the business office to recognize or resolve potential payment problems.
Monitor client length of stay and extensions, informing clinical and medical staff of any issues that may impact length of stay; investigate short-term stays and develop alternate financial plans when appropriate.
Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges, and quality of services as required by leadership or corporate office.
Conduct quality reviews for medical necessity and services provided; facilitate peer review calls between the facility and external organizations; identify potential review problems and discuss with the multidisciplinary team or administration.
Act as liaison between managed care organizations and the facility’s professional clinical staff.
Assist with any problems encountered during on-site or telephone reviews by third-party payers or review organization.
Education, Experience & Skill Requirements
High School diploma or equivalent required; graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field preferred.
One or more years of direct clinical experience in a substance abuse setting required; ASAM experience preferred.
At least one year of experience in utilization review preferred.
Why Anabranch Recovery Center? The center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume.
Anabranch Recovery Center is an Equal Opportunity Employer. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country, recognizing and valuing the unique strengths of the military community.
#J-18808-Ljbffr