Utilization Management Specialist

Overview:
Ascension Saint Thomas Behavioral Health Hospital is seeking a skilled UM Specialist to join our team of professionals. As Nashville’s leading behavioral health hospital, we provide a full continuum of behavioral health treatment services for adults and seniors. Our goal is to deliver compassionate, personalized care to those who turn to us in their time of need.
BENEFITS:
Ascension St Thomas Behavioral Health provides a comprehensive package of benefits for our Utilization Management staff. Current benefits include:
Competitive hourly rate
Medical, dental, and vision insurance
Competitive PTO plans
Employee Discount Program
Employee Disaster Assistance Program
Acadia Healthcare 401(k) plan
Excellent training program
Professional growth opportunity that is second to none in the industry. Join a team with defined career paths and a national family of hospitals and facilities
Responsibilities:
ESSENTIAL FUNCTIONS:
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.
OTHER FUNCTIONS:
Perform other functions and tasks as assigned.
Qualifications:
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field is required.
Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
Current licensure as an LPN or RN 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.
First aid may be required based on state or facility requirements.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
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