Utilization 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

Location

On-site position located in Lancaster, SC

Sign On Bonuses

• MSW or ASN RN $6,000 Sign On Bonus
• BSN RN $10,000 Sign On Bonus

Pay Rate

Pay Rate: $22 - $42/Hr. Dependent upon Experience and Qualifications

Purpose Statement

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

About Us

As one of the leading inpatient treatment programs in South Carolina, Rebound Behavioral Health Hospital offers short-term, recovery-oriented treatment for mental health disorders, substance abuse, and co-occurring concerns. Our approach is designed to rapidly identify treatment strategies for all who come to us that promote recovery and provide the stabilization necessary to help our clients return to their community as happy, productive members. Our inpatient program provides an interdisciplinary staff who serve as experts and work alongside our clients to assist each person who comes to us to identify and reach treatment goals. As our treatment program is largely group-focused, clients can draw from input from staff, peers, and the treatment milieu as they regain stability and prepare to return to their home environment. Our treatment professionals include:

• Licensed social workers
• Substance abuse counselors
• Board-certified psychiatrists
• Recreational and expressive therapists
• Psychiatric and substance abuse nurses
• Behavioral health technicians

Essential Functions

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• 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 the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Other Functions

• Perform other functions and tasks as assigned.

Education/Experience/Skill Requirements

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

Licenses/Designations/Certifications

• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
• First aid may be required based on state or facility requirements.

Additional Regulatory Requirements

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

AHMKT