Utilization Specialist - Full Time

Acadia Healthcare • San Jose, CA

10d • Onsite

About The Position

San Jose Behavioral Health is seeking a Utilization Review Specialist to assist the Utilization Department staff with comprehensive inpatient care and treatment within their 133-bed Acute Psychiatric Hospital. This role coordinates and assesses the inpatient census for appropriate alternate health care service needs. Responsibilities include performing on-site and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines. The specialist will also coordinate with appropriate discharge planning processes, providing feedback on documentation processes, and function as a resource to the clinical team regarding approved criteria, practice guidelines, and alternative treatment options.

Requirements

• Associate Degree in Nursing (LPN/LVN/RN) Required.
• LMFT, 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.
• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).

Nice To Haves

• Bachelors or Masters degree in Social Work, Behavioral Health Or Mental Health, Nursing or Other related health field preferred.
• Two or more year's experience with the population of the facility preferred.
• Previous experience in utilization management is preferred.

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

• Competitive salary
• Medical, dental, and vision insurance
• Acadia Healthcare 401(k) plan with match
• General Paid Time off to include: Vacation, Sick, Personal Days, and Extended Sick Leave plus Holidays/Holiday Pay
• Excellent training program
• Professional growth opportunity that is second to none in the industry.
• Defined career paths and a national family of hospitals and facilities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree