What are the responsibilities and job description for the Utilization Review Specialist position at Acadia Behavioral Health (Pioneer Behavioral Health)?
Come join our team as a Utilization Review Specialist at River Place Behavioral Health! If you are passionate and dedicated to making a difference in the lives of those in need through compassionate therapeutic practices while working in a team environment that supports learning and growth, this position is right for you!
River Place Behavioral Health Hospital, a service of Ochsner Health System, is an 82 bed state of the art hospital located in Laplace, Louisiana.
As a Utilization Review Specialist at River Place you will participate in the development and implementation of patients' treatment plan by:
-Providing consultation and guidance regarding admissions and patient length of stay to a variety of payers.
-Securing authorizations with insurance companies for inpatient treatment and continue to obtain authorizations through ongoing clinical reviews until patient discharges from treatment.
-Evaluating the utilization operation for compliance with mandatory policies and procedures.
-Reviewing clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
-Maintaining efficient, positive customer service attitude towards patients, their families and co-workers while being responsive to customer needs.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
· Associate's degree in nursing (LPN or RN) required. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
· 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 with the state of LA; or current clinical professional license or certification, as required.
