Clinical Utilization & Reimbursement Specialist

Acadia Healthcare; Riverdale (GA); Presencial; USD 55 000 - 75 000; Tempo integral

Resumo da oferta

Acadia Healthcare seeks a utilization management professional to proactively monitor service utilization and optimize reimbursement for the Georgia facility.

In this role you will liaison between managed care organizations and the facility clinical staff, review plans for medical necessity, and coordinate communications on reimbursement requirements. Clinical experience and utilization management background are preferred; CPR and de-escalation training may be required.

Qualificações

• Clinical experience is required, or two or more years' experience with the facility population.
• Utilization management experience is preferred.
• CPR and de-escalation training required (training available upon hire).

Responsabilidades

• Act as liaison between managed care organizations and the facility clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations 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, discharges and quality of services.
• 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.
• Perform other functions and tasks as assigned.

Conhecimentos

Clinical experience

Formação académica

High school diploma or equivalent

Associate's, Bachelor's, or Master's in Social Work, Behavioral or Mental Health, Nursing, or related health field

Descrição da oferta de emprego

Acadia Healthcare seeks a utilization management professional to proactively monitor service utilization and optimize reimbursement for the Georgia facility.

In this role you will liaison between managed care organizations and the facility clinical staff, review plans for medical necessity, and coordinate communications on reimbursement requirements. Clinical experience and utilization management background are preferred; CPR and de-escalation training may be required.