Utilization Review Specialist

UHS • Benton, AR

99d

About The Position

Rivendell Behavioral Health Services is an 80-bed full-service behavioral healthcare acute care facility located in Benton, AR, that has been providing quality health care to the residents of Arkansas since 1985. Rivendell Behavioral Health Services has been offering hope to individuals, families, and communities for over 30 years. Rivendell Behavioral Health Services is the leader in providing quality mental health and addiction treatment services. Our commitment to care includes developing integrated delivery systems through partnerships with medical surgical hospitals, community mental health centers, educational institutions, managed care organizations, local health professionals and agencies. Rivendell Behavioral Health Services strives to set the standard for excellence in the field of behavioral health care and maintains its leadership role by treating each patient as a respected individual of our community. Rivendell Behavioral Health Services of Arkansas is seeking a Utilization Review Specialist for full time status. The Utilization Review Specialist ensures that inpatient admissions & continued hospital stays are medically necessary and that patients receive the highest quality of health care in the most resourceful manner.

Requirements

• Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
• Current licensure as a Nurse with at least one year psychiatric experience or Licensed Social Worker with LMSW or LCSW is preferred.
• Computer skills necessary.

Responsibilities

• Reviews documentation to support severity of illness, intensity of services, need for current level of treatment, and notifies supervisor of any deficiencies.
• Conducts admissions and continued-stay reviews with payors (Medicaid, Medicare, private insurance) for authorizations and reports to treatment team and supervisor any certification problems.
• Reviews the denial and appeals process for assigned caseload by identifying cases with potential for denial, identifies actions, which need to occur to avoid denials and follows through with process for appealing actual denials.
• Is responsible for assuring that all disciplines (nursing, therapy, recreational therapy, physician, education) are documenting quality progress notes as required. Any instances of noted deficiencies will be reported immediately to supervisor.
• Communicates with the clinicians and other departments regarding certification or payor issues that impact length of stay. Is able to communicate patient’s payor status to physician to include quality issues and necessity for doctor to doctor review. Is able to communicate available options for patients.
• Maintains a good working relationship with referral sources as well as knowledge of community resources. May occasionally act as a resource to others relating to aftercare options.
• Strong communication skills with the ability to build a good working rapport with customers, clinicians, physicians, and staff are imperative to a having success as a Utilization Review Specialist.

Benefits

• Challenging and rewarding work environment
• Competitive Compensation
• Excellent Medical, Dental, Vision, and Prescription Drug Plan
• Generous Paid Time Off
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its Subsidiaries

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees