Strategic Utilization & Reimbursement Specialist

Harboroaks; Henderson (NV); On-site; USD 60,000 - 80,000; Full time

Job summary

Harboroaks in Henderson, NV is seeking a professional to monitor service utilization to optimize reimbursement. You will act as liaison between managed care organizations and the facility's clinical staff, coordinating reviews and communication on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering data for reports, conducting quality reviews for medical necessity, and facilitating pre-certifications of care.

Qualifications

• High school diploma or equivalent required.
• Clinical experience or 2+ years working with facility population; utilization management experience preferred.
• Preferred licensure include LPN, RN, LMSW, LCSW, LPC or LPC-I within the state.
• CPR and de-escalation/ restraint certification required; first aid may be required per state or facility.

Responsibilities

• Act as liaison between managed care organizations and the facility's clinical staff.
• Conduct reviews of insurance plans or MCOs and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform staff of issues affecting stay.
• Gather and report statistics on utilization, non-certified days, discharges and quality of services.

Skills

Clinical experience

Utilization management

Communication skills

Documentation accuracy

Education

High school diploma

Associate/Bachelor/Master in Social Work or related health field

Job description

Harboroaks in Henderson, NV is seeking a professional to monitor service utilization to optimize reimbursement. You will act as liaison between managed care organizations and the facility's clinical staff, coordinating reviews and communication on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering data for reports, conducting quality reviews for medical necessity, and facilitating pre-certifications of care.