Utilization & Reimbursement Specialist

Rebound Behavioral Health Hospital; Lancaster (SC); On-site; USD 46,000 - 87,000; Full time

Benefits offered by this job

Sign-on bonus: MSW/ASN RN $6,000

Sign-on bonus: BSN RN $10,000

Job summary

Rebound Behavioral Health Hospital in Lancaster, SC, is seeking a dedicated utilization management professional for an on-site role. You will act as a liaison with managed care organizations, review plans for reimbursement and monitor patient length of stay to keep clinical staff informed of issues that could affect stay duration.

Education includes a high school diploma; preferred degrees in social work, behavioral/mental health or nursing.

Qualifications

• High school diploma or equivalent is required.
• Preferred degrees in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Clinical experience is required; two or more years with the facility's population recommended.
• Experience in utilization management is preferred.

Responsibilities

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and inform clinical staff on issues affecting stay duration.
• 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 between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing training for staff on documentation or charting requirements and medical necessity updates.

Skills

Clinical experience

Utilization management

Communication skills

Education

High school diploma or equivalent

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

Job description

Rebound Behavioral Health Hospital in Lancaster, SC, is seeking a dedicated utilization management professional for an on-site role. You will act as a liaison with managed care organizations, review plans for reimbursement and monitor patient length of stay to keep clinical staff informed of issues that could affect stay duration.

Education includes a high school diploma; preferred degrees in social work, behavioral/mental health or nursing.