Utilization Specialist

Acadia • Murfreesboro, TN

2d • Onsite

About The Position

Join our team at TrustPoint Hospital as a Full Time Utilization Specialist! We are seeking passionate professionals that are dedicated to behavioral health. If you are looking for unparalleled growth opportunities and are wanting to make a meaningful impact in your community, this is the position for you! TrustPoint Hospital is a 217-bed, state-of-the-art treatment center providing comprehensive medical and psychiatric services on both inpatient and outpatient bases. We deliver exceptional care to patients needing acute physical medicine and rehabilitation, adult, adolescent, geriatric psychiatry, and medical psychiatry.

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.
• 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.

Benefits

• Medical, Dental, and Vision Insurance coverage
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options
• Company-paid Basic Life & AD&D insurance
• Disability benefits
• 401(k) Retirement Plan with a company match
• Employee Assistance Program (EAP) and Employee Discount Program
• Paid Holidays for work-life balance
• Paid Time Off (PTO)
• Tuition Reimbursement opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED