Healthcare Utilization & Reimbursement Specialist

Acadia Healthcare; Magee (MS); In loco; USD 45.000 - 75.000; Tempo pieno

Descrizione del lavoro

Harboroaks in Mississippi seeks a dedicated Utilization Review Specialist to monitor patient service utilization and optimize reimbursement for the facility. You will liaise with managed care plans and clinical staff, ensuring compliance with certification requirements and coordinating communication on reimbursement needs.

The role requires on-site work, clinical experience, and proficiency in reviewing medical necessity and authorization processes, with duties extending to staff education on

Competenze

• Required education: high school diploma or equivalent.
• Preferred degrees in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Experience: utilization review experience required; clinical experience with the facility's population preferred.
• Must work on site at the facility.

Mansioni

• Act as liaison between managed care organizations and the facility clinical staff.
• Conduct reviews of insurance plans or MCOs and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform staff on issues that may impact length of stay.
• Gather and develop data to report on utilization, discharges and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls with external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing support and training for staff on documentation and stay criteria updates.

Conoscenze

Utilization review experience

Clinical experience

On-site work

Formazione

High school diploma or equivalent

Associate's degree

Bachelor's degree

Master’s degree

Descrizione del lavoro

Harboroaks in Mississippi seeks a dedicated Utilization Review Specialist to monitor patient service utilization and optimize reimbursement for the facility. You will liaise with managed care plans and clinical staff, ensuring compliance with certification requirements and coordinating communication on reimbursement needs.

The role requires on-site work, clinical experience, and proficiency in reviewing medical necessity and authorization processes, with duties extending to staff education on