Utilization Review Specialist
Utilization Review Specialist
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Mirror Lake Recovery Center has been supplying top-notch addiction treatment that sets the standard of true clinical excellence. Located in scenic Burns Tennessee this centers campus is situated on 75 tranquil acres and provides proven effective treatment that is able to transform the lives of all who come to Mirror Lake to defeat an addiction to drugs and/or alcohol.
Are you a Registered Nurse looking to use your skill set in a different way Then consider applying for our UR Specialist position! Check out the details below:
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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
