Utilization Review Specialist: Optimize Reimbursement & Care

Acadia Healthcare; Fayetteville (AR); Sur place; USD 60 000 - 75 000; Plein temps

Résumé du poste

Vantage Point Behavioral Health Hospital in Fayetteville, AR is seeking a Full Time Utilization Review Specialist. The role focuses on proactively monitoring utilization of services to optimize reimbursement and coordinating with managed care organizations and clinical staff.

Responsibilities include conducting reviews for medical necessity, supporting documentation, and managing the appeal process for denied admissions or continued stay, while assisting admissions with pre-certifications and

Qualifications

• Required Education: High school diploma or equivalent.
• Clinical experience is required, or two or more years' experience working with the facility's population.
• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, or similar clinical license as required by the state.

Responsabilités

• Monitor utilization of services to optimize reimbursement for the facility.
• 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 notify staff of issues affecting stay length.
• Gather and develop information 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 staff training on documentation, stay criteria and medical necessity updates.

Connaissances

Clinical experience

CPR certification

Formation

High school diploma or equivalent

Bachelors/Associate/Master in Social Work or Nursing (preferred)

Description du poste

Vantage Point Behavioral Health Hospital in Fayetteville, AR is seeking a Full Time Utilization Review Specialist. The role focuses on proactively monitoring utilization of services to optimize reimbursement and coordinating with managed care organizations and clinical staff.

Responsibilities include conducting reviews for medical necessity, supporting documentation, and managing the appeal process for denied admissions or continued stay, while assisting admissions with pre-certifications and