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Utilization Review Specialist - Bachelor's Social Work License

Acadia Behavioral Health (Pioneer Behavioral Health)
Magee, MS Full Time
POSTED ON 3/5/2024
Employment Type: Full-Time
  • 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.

Salary.com Estimation for Utilization Review Specialist - Bachelor's Social Work License in Magee, MS
$65,762 to $84,353
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