Utilization Review Specialist
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Job Location:
Riverside, CA - USA
Monthly Salary:
$ 25 - 37
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
We offer a full of benefits ranging from:
- 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
Hourly Range: $25.00 $37.47
Pacific Grove Hospital is a nationally recognized 68 bed acute psychiatric and chemical dependency treatment center offering inpatient & outpatient services for psychiatric illnesses addictions & co-occurring disorders. Our hospital offers comprehensive training dynamic leadership and personalized support so you can achieve your greatest potential.
Utilization Review Specialist include
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:
- Associates degree in nursing (LPN or RN) required. Bachelors or Masters degree in social work behavioral or mental health nursing or other related health field preferred.
- Two or more years experience with the population of the facility and previous experiencein utilization management preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Current licensure as an LPN or RN 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.
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Acadia Healthcare operates a network of premier behavioral healthcare facilities in the United States and Puerto Rico. Offering multiple levels of care for all populations.
