Utilization Specialist - Full Time
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. Medi-Cal Experience and Understanding Preferred
Requirements
- High school diploma or equivalent.
- 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.
Nice To Haves
- Associate's, Bachelor's, or M aster’s degree in S ocial W ork , B ehavioral or M ental H ealth, N ursing, or a related health field.
- Previous experience in utilization management is preferred
- UM Experience preferred
- Medi-Cal experience and understanding preferred
- 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.
- First aid may be required based on state or facility requirements.
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 extension s and i nform 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.
Benefits
- Competitive hourly rate
- Shift differential for overnight shifts
- Medical, dental, and vision insurance
- Acadia Healthcare 401(k) plan
- Excellent training program
- Complimentary AOD Education to certify as a Substance Use Disorder Counselor
- Professional growth opportunity that is second to none in the industry.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
