Utilization Review Specialist

Vantage Point Behavioral Health • Fayetteville, AR

2d • Onsite

About The Position

Vantage Point Behavioral Health Hospital is seeking a full-time Utilization Review Specialist at its Fayetteville, Arkansas location. The role proactively monitors patient service utilization to optimize facility reimbursement and serves as a liaison between managed care organizations and facility clinical staff. The specialist conducts reviews according to certification requirements for insurance plans and other managed care organizations, and coordinates communication concerning reimbursement requirements.

The role monitors patient length of stay and extensions, conducts medical-necessity and service-quality reviews, supports pre-certifications, and manages appeals for denied admissions or continued stays. It also develops utilization reports and provides staff support and training on documentation, continued-stay criteria, and medical-necessity updates. Other functions and tasks may be assigned.

Requirements

• High school diploma or equivalent.
• Clinical experience, or two or more years of experience working with the facility's population.
• CPR certification and de-escalation and restraint certification are required; training is available upon hire and offered by the facility.
• First aid may be required based on state or facility requirements.

Nice To Haves

• Associate's, bachelor's, or master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Previous experience in utilization management.
• LPN, RN, LMSW, LCSW, LPC, or LPC-I licensure within the state where the facility provides services, or a current clinical professional license or certification required in that state.

Responsibilities

• Monitor patient length of stay and extensions, and inform clinical and medical staff about issues that may affect length of stay.
• Gather and develop statistical and narrative information on utilization, non-certified days and their identified causes, appeal information, discharges, and quality of services for facility leadership or the corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between the facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stays.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing staff support and training on documentation or charting requirements, continued-stay criteria, and medical-necessity updates.
• Perform other functions and tasks as assigned.

What This Job Offers

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