Healthcare Utilization & Appeals Specialist
Summit BHC
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Benefits offered by this job
Job summary
Summit BHC's Raleigh Oaks Behavioral Health in Garner, North Carolina is seeking an Utilization Review Specialist to evaluate admissions, continued stays, and discharge planning under approved criteria. You will coordinate UR activities to improve reimbursement and care coordination.
The role requires RN/LPN licensure or related health field degree, 2+ years of psychiatric clinical experience, and effective communication with physicians, insurers, and staff.
Qualifications
- Two or more years of direct clinical experience in a psychiatric or mental health setting.
- Current licensure as an RN or LPN, or a related professional license, as required by the state.
- Graduation from an approved/accredited school of nursing or a related health field.
Responsibilities
- Review admissions, continued stays, and discharge planning using established criteria.
- Coordinate utilization review activities to improve reimbursement and information presentation.
- Educate hospital staff about utilization review requirements and trends.
- Communicate with physicians, insurers, and providers regarding utilization needs and approvals.
- Monitor length of stay and assist with discharge planning as needed.
- Maintain accurate documentation for utilization management and reporting.
Skills
Education
Job description
Summit BHC's Raleigh Oaks Behavioral Health in Garner, North Carolina is seeking an Utilization Review Specialist to evaluate admissions, continued stays, and discharge planning under approved criteria. You will coordinate UR activities to improve reimbursement and care coordination.
The role requires RN/LPN licensure or related health field degree, 2+ years of psychiatric clinical experience, and effective communication with physicians, insurers, and staff.
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