Acute Care Utilization & Discharge Specialist

Pavilion-At-Williamsburg-Plac; Williamsburg (VA); On-site; USD 60,000 - 80,000; Full time

Job summary

The Pavilion at Williamsburg Place is seeking a Utilization Specialist - Acute to review admissions, continued stays, and discharge planning in accordance with approved criteria. This role ensures timely authorizations and supports utilization management activities across the hospital.

Responsibilities include communicating with insurers and physicians, coordinating appeals, and assisting with pre-certifications and benefit verifications.

Qualifications

• 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 required.
• Two or more years of direct clinical experience in a psychiatric or mental health setting required.
• Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.

Responsibilities

• Reviews admissions, concurrent, continued stay, and retrospective reviews using established criteria.
• Communicates with insurance companies and HMOs for approval of inpatient days.
• Appeals denials and coordinates the appeal process.
• Assists with pre-certifications of care and benefit verification with managed care organizations.
• Maintains documentation and supports staff with charting requirements.
• Coordinates with business office to resolve potential payment issues.
• Monitors length of stay and informs staff of issues impacting stays.
• Participates in discharge planning as required.

Skills

Interdisciplinary collaboration

Physician/provider communication

Documentation accuracy

Education

Bachelor's degree in nursing or related health field

Job description

The Pavilion at Williamsburg Place is seeking a Utilization Specialist - Acute to review admissions, continued stays, and discharge planning in accordance with approved criteria. This role ensures timely authorizations and supports utilization management activities across the hospital.

Responsibilities include communicating with insurers and physicians, coordinating appeals, and assisting with pre-certifications and benefit verifications.