Utilization Review Specialist
Utilization Review Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
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 noncertified 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 precertifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements continued stay criteria and medical necessity updates.
- Hours:Tuesday Saturday 8:00 am 5:00 pm
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
LPN Diploma with a current NC Nursing license OR Associates Degree in Nursing (RN) with current NC Nursing license OR Bachelors Degree in Social Work Behavioral Health Mental Health or other related healthcare field required
- CPR and CPI certification (training offered onsite)
- Teamwork and excellent customer service
PREFERRED:
- Masters Degree in Social work behavioral Health Mental Health or other healthcare related field preferred
- Current NC clinical professional licensure/certification preferred
- Two or more years experience with the population of the facility and previous experiencein utilization management preferred.
BENEFIT/COMPENSATION (after 30 days of employment):
- BC/BS Health Insurance 3 plans to choose from eligible after 30 days of employment)
- Delta Dental 2 plans to choose from)
- NVA Vision Insurance
- Paid life and AD&D insurance
- 401k with a matching contribution
- Vacation/Sick/Extended Sick
- Personal/Holiday time
- Short term and Long term disability
- Free onsite employee fitness center
- Free meals
- Employee Discount program
- Employee Fun events
- Annual Performance Review and Merit Increase Review
- Salary increases for obtaining education degrees professional certification and/or licensure (based on program of study/ field of certification and licensure)
- License/Certification renewal and reimbursement
Ranked by Newsweek in 2020 and 2021 as one of North Carolinas Best Addiction Treatment Centers Wilmington Treatment Center is North Carolinas premier substance abuse recovery hospital and rehabilitation center located in the beachside community of Wilmington NC. What began as a 22 bed hospital on one campus in 1984 has grown into a 260 bed hospital spanning 3 campuses! We are a team of professionals dedicated to helping our patients begin their recovery from the disease of addiction. Even though we are growing we still maintain that feeling of a close knit community. We offer a fantastic comprehensive benefit package a great team of coworkers as well as the opportunity to make a difference in the lives of those we serve.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
