Utilization Specialist - Full Time

Harboroaks; Scotts Valley (CA); On-site; USD 34,440 - 37,195; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Acadia Healthcare 401(k) plan

Excellent training program

Professional growth opportunity

Job summary

Harboroaks is hiring a full-time Utilization Specialist for The Camp Recovery Center in Scotts Valley, CA. This role involves acting as a liaison between managed care organizations and clinical staff, ensuring safety for clients undergoing treatment.

A high school diploma is required, while a degree in a related field is preferred. The position offers a competitive hourly rate between $25.00 - $27.00 and comes with benefits including medical insurance and a 401(k) plan.

Qualifications

• Required Education: High school diploma or equivalent.
• Preferred Education: Higher degree in a health-related field.
• Clinical experience is required, or experience with the facility's population.

Responsibilities

• Act as liaison between managed care organizations and clinical staff.
• Monitor patient length of stay and ensure necessary updates.
• Conduct quality reviews for medical necessity.

Skills

Clinical experience

Experience with facility's population

Medi-Cal experience

Utilization management experience

Education

High school diploma or equivalent

Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related field

Tools

CPR certification

De-escalation and restraint certification

Job description

Overview

Utilization Specialist Opportunity (8 hours shifts) at The Camp Recovery Center – Scotts Valley, CA

Pay Range $25.00 - $27.00

We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley. This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.

Medi-Cal Experience and Understanding Preferred

Responsibilities

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.

Qualifications

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
• UM Experience preferred
• Medi-Cal experience and understanding 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.

COMPENSATION:

Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

Role Location: CALIFORNIA

Calculated Hourly Range for role Utilization Specialist

State – California: $25.00 - $27.00

BENEFITS: For Full Time Staff only

The Camp Recovery Center provides a comprehensive package of benefits for our Full Time Utilization Specialist. Current benefits include:

• Competitive hourly rate
• Shift differential for overnight shifts
• Medical, dental, and vision insurance
• Acadia Healthcare 401(k) plan
• Excellent training program
• Complimentary AOD Education to certify as a Substance Use Disorder Counselor
• Professional growth opportunity that is second to none in the industry.

AVAILABILITY AND HOURS:

This is a Full-Time EMT position Monday - Friday. Shifts are 8 hours, and are overtime eligible.

ADDITIONAL REGULATORY REQUIREMENTS:

As Needed

Equal Employment Opportunity: 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.