Utilization Review Specialist

Acadia Healthcare•Fort Myers, FL

About The Position

Do you have great attention to detail? Have experience in Utilization Review? Want to work in a positive, respectful environment where you will be challenged to be the very best? If you said "yes", then we are interested in you!Park Royal Hospital, Southwest Florida's premier behavioral health system has an opening for a full-time UR Specialist. As part of the Acadia Health Care system, Park Royal offers great benefits, education, growth and, most importantly, a supportive, team-focused culture that is second to none. Be recognized and rewarded for being the very best! In this role, you will: Act as liaison between managed care organizations and the facility's 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. Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients. Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients. Facilitate peer review calls between facility and external organizations. Act in coordination with the leadership team of the facility or corporate office to improve the quality of services provided within the organization. Assist the admissions department with pre-certifications of care. Initiate and complete the formal appeal process for denied admissions or continued stay. Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 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. And more! 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.

Requirements

great attention to detail
experience in Utilization Review

Responsibilities

Act as liaison between managed care organizations and the facility's 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.
Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients.
Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients.
Facilitate peer review calls between facility and external organizations.
Act in coordination with the leadership team of the facility or corporate office to improve the quality of services provided within the organization.
Assist the admissions department with pre-certifications of care.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
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.