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Utilization Review Specialist

Company: Camp Recovery
Location: Riverside
Posted on: November 18, 2021

Job Description:

* Competitive Salary * Medical, Dental, And Vision Insurance * Acadia 401K Plan * Professional Growth * Paid Holiday, Personal Time, Sick time * Opportunity for growth ESSENTIAL FUNCTIONS: LVN License required * 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.

Keywords: Camp Recovery, Riverside , Utilization Review Specialist, Other , Riverside, California

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