Utilization & Case Review Specialist

Summit BHC; Williamsburg, Northern (VA, KY); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Summit BHC’s Pavilion at Williamsburg Place is seeking an Utilization Specialist to review admissions, ongoing stays, and discharge planning using approved criteria, meeting daily deadlines to obtain authorizations and complete related processes.

You will coordinate utilization review activities, educate staff on requirements, and monitor length of stay while coordinating with physicians and insurers to optimize patient care and reimbursement.

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.

Responsibilities

• Review admissions, concurrent reviews, continued stays, and discharge planning according to approved criteria.
• Communicate with insurers and providers for authorization of inpatient days.
• Appeal denials and coordinate the appeal process.
• Assist with pre-certifications and benefit verification for managed care organizations.
• Maintain accurate utilization management documentation and reporting.

Skills

Communication

Clinical experience

Education

Nursing degree or related health field

Job description

Summit BHC’s Pavilion at Williamsburg Place is seeking an Utilization Specialist to review admissions, ongoing stays, and discharge planning using approved criteria, meeting daily deadlines to obtain authorizations and complete related processes.

You will coordinate utilization review activities, educate staff on requirements, and monitor length of stay while coordinating with physicians and insurers to optimize patient care and reimbursement.