Utilization Review Specialist: Medical Necessity & Appeals

Vantage Point Behavioral Health Hospital; Fayetteville (AR); Sur place; USD 45 000 - 65 000; Plein temps

Résumé du poste

Vantage Point Behavioral Health Hospital in Fayetteville, AR is seeking a Full Time Utilization Review Specialist to proactively monitor utilization of services and optimize reimbursement for the facility.

The role acts as a liaison between managed care organizations and clinical staff, conducts reviews for certification requirements, and coordinates communication regarding reimbursement.

Qualifications

• High school diploma or equivalent required.
• Preferred degrees: Associate's, Bachelor's, or Master's in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Clinical experience required, or two+ years with the facility population; utilization management experience preferred.

Responsabilités

• Monitor length of stay and inform staff on issues affecting LOS.
• Gather statistics and narrative reports on utilization, non-certified days, discharges and quality of services.
• Conduct quality reviews for medical necessity and services.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing training for staff on documentation, continued stay criteria and medical necessity updates.

Connaissances

Clinical experience

Utilization management

MCO liaison

Formation

High school diploma or equivalent

Associate's degree

Bachelor's degree

Master’s degree

Description du poste

Vantage Point Behavioral Health Hospital in Fayetteville, AR is seeking a Full Time Utilization Review Specialist to proactively monitor utilization of services and optimize reimbursement for the facility.

The role acts as a liaison between managed care organizations and clinical staff, conducts reviews for certification requirements, and coordinates communication regarding reimbursement.