UR Specialist

Acadia External • Brooksville, FL

9d • Onsite

About The Position

Sabal Palms Recovery Center, an addiction treatment facility nestled on a 10-acre campus, is seeking a Full Time Utilization Review Specialist to join their team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week. Sabal Palms Recovery Center provides premier residential treatment for adults aged 18 and older who are struggling with addictions. Our skilled professionals are focused on sharing their knowledge and expertise to help you get acclimated to your new role. Along with detailed training and continual support, our staff will give you the autonomy you need to achieve your career goals. You will love working to make a difference in the lives of our patients as you collaborate with other professionals and a supportive management team.

Requirements

• High School diploma or equivalent required.
• CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).
• First aid may be required based on state or facility.

Nice To Haves

• Two or more years' experience with the population of the facility
• Previous experience in utilization management preferred.

Responsibilities

• 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.

Benefits

• Medical, Dental, and Vision Insurance
• HSA & FSA
• Company Paid Basic Life & AD&D
• Disability
• 401(k) Retirement Plan - with company match
• Employee Assistance Program/Employee Discount Program
• Paid Holidays
• Paid Time Off
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED