Utilization Specialist - Full Time

Acadia Healthcare•Scotts Valley, CA

3d•$25 - $27

About The Position

Utilization Specialist Opportunity (8hours shifts) at The Camp Recovery Center – Scotts Valley, CA Pay Range$25.00 - $27.00: We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley! This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis. Médi-Cal Experience and Understanding Preferred

Requirements

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

Nice To Haves

Preferred Education: 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 is preferred
UM Experience preferred
Medi-Cal experience and understanding preferred
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

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.
Perform other functions and tasks as assigned.