Utilization Review Specialist

Acadia Healthcare • Fayetteville, AR

1d • 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 the utilization of patient services to optimize facility reimbursement and serves as a liaison between managed care organizations and facility clinical staff. The specialist conducts reviews in accordance with certification requirements and coordinates communications about reimbursement requirements.

Requirements

• High school diploma or equivalent.
• Clinical experience, or at least two years of experience working with the facility's population.
• CPR certification and de-escalation and restraint certification; training is available upon hire and offered by the facility.

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 in the state where the facility provides services, or a current clinical professional license or certification required in that state.
• First aid may be required based on state or facility requirements.

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 causes, appeals, discharges, and quality of services, as required by 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 formal appeals for denied admissions or continued stays.
• Assist the admissions department with care pre-certifications.
• Provide ongoing staff support and training on documentation and 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