Utilization Review Specialist-FT

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility while monitoring the use of the patient's provider benefits for their specific needs.

* Responsible for conducting concurrent and discharge reviews for patients admitted to our inpatient behavioral health facility.

* Record all communication with Managed Care Organizations in accounting system.

* Educates members of the treatment team on documentation standards.

* Works closely with the physician, social worker, and nurses to coordinate treatment and to communicate issues regarding discharge planning, length of stay and payer issues.

* Reports all denials to Director of UR immediately, and facilitates peer review calls between facility and external organizations.

* Completes appeals for denied days and retrospective authorization requests when necessary.

* Completes insurance authorizations and concurrent reviews for IOP.

* Necessary skills include: pattern recognition, independence, critical thinking, time efficiency, organizational skills, attention to detail, knowledge of psychiatric medications, ability to work with all levels of leadership, customer service.

LICENSES: * Preferred Licensure: LPN, RN, LSW, Licensed Chemical Dependency Counselor, Chemical Dependency Counselor Assistant as required, within the state where the facility provides services.

Will consider a non-licensed individual with strong behavioral health or insurance coordination background.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.

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