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Utilization Review Specialist

at Acadia Healthcare in Fayetteville, Arkansas, United States

Job Description

Description

+ 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.

+ Perform other functions and tasks as assigned.

MUST BE ABLE TO PASS DRUG SCREEN and BACKGROUND TESTS

Qualifications

Skills

Required

+ Oral Communication: Intermediate

+ Problem Solving: Some Knowledge

+ Planning & Organizing: Intermediate

+ Networking: Some Knowledge

+ Financial Awareness: Some Knowledge

+ Attention to Detail: Intermediate

Behaviors

Required

+ Team Player: Works well as a member of a group

+ Innovative: Consistently introduces new ideas and demonstrates original thinking

+ Loyal: Shows firm and constant support to a cause

+ Enthusiastic: Shows intense and eager enjoyment and interest

+ Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

+ Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

Required

+ Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

+ Self-Starter: Inspired to perform without outside help

+ Goal Completion: Inspired to perform well by the completion of tasks

+ Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals

Education

Required

+ High School/GED or better

Preferred

+ Bachelors or better in Nursing/Healthcare

+ Associates or better in Nursing/Healthcare

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or © consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35©

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Job Posting: JC195251595

Posted On: Oct 18, 2021

Updated On: Nov 05, 2021