Utilization Specialist

Serenity Knolls•Forest Knolls, CA

3d•$28 - $30•Remote

About The Position

Serenity Knolls, located in the San Geronimo Valley, is seeking an experienced Utilization Specialist. Our facility has a capacity of 42 beds and serves individuals aged 18 and older, including 6 beds designated for detox. As a 12-step based, social model residential treatment center, Serenity Knolls combines traditional social models of care with contemporary cognitive behavioral, psychodynamic, and evidence-based practices. The purpose of this role is to diagnose and treat mental and emotional disorders, whether cognitive, affective or behavioral. Compensation for roles at Serenity Knolls varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, Serenity Knolls provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below. Pay rate: $28 - $30 per hour. This may be a remote position.

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).
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 is 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.