Utilization Specialist

Life Center of Galax•Galax, VA

About The Position

Come join our team as a Utilization Review Specialist, Life Center of Galax-Hillsville! We are looking for individuals who are passionate about behavioral health. If you are interested in growth opportunities that are second to none in the industry and making a difference in the lives of people in our community, this position is right for you! Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Excellent benefits package: -Company matching 401k-Health, Dental, & Vision Insurance-Disability and life insurance-Paid holidays, vacation, sick, and extended sick time

Requirements

Required Education: High school diploma or equivalent.
Experience: 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

Preferred Education: 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.
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 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.