Utilization Review Specialist Full-time
Utilization Review Specialist Full-time
Posted on :
30-09-2025
Employer Active
1 Vacancy
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Job Description
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
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: Associates Bachelors or Masters 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 facilitys 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.
Our Full-time benefit package offers the following:
- Competitive Salary
- Paid Time Off
- Paid Holidays (8 Total)
- Medical Dental & Vision Insurance
- FSA & HSA Plans
- Long-Term & Short-Term Disability
- Company Paid Life Insurance
- Supplemental Life Insurance
- Employee Assistance Program
- Employee Discount Program
- 401(k) Retirement Plan with Company Match
- Many employee-centered events throughout the year!
Hourly pay range: $31-50 Dependent on candidates current licensure and experience.
Required Experience:
IC
Employment Type
Full-Time
Key Skills
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