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 Specialist at Agave Ridge Behavioral Hospital, the newest in the Acadia family! As part of our team, you will benefit from detailed training, ongoing support, and continued opportunities to develop new skills and move forward in your chosen profession. You'll also know that you are playing a vital role in an organization that is providing an essential service to those in our community.
We offer a full suite of benefits ranging from:
- Growth Opportunities second to none in the industry
- Competitive hourly rates
- 401(k) Retirement Plan - with company match
- Employee Assistance Program/Employee Discount Program
Hourly rates are dependent upon experience. They start at $29.00 and range up to $37.00 per hour.
This is an on-site role located at our brand-new facility in Mesa.
At Agave Ridge we specialize in serving adolescents ages 11-17, adults age 18 , and senior adults age 55 who are struggling with mental health concerns and substance use disorders. We provide holistic, age-appropriate care that addresses our patients’ mental, physical, emotional, and social needs so that they can wholly heal.
Responsibilities will include:
- 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.
We are an Equal Employment Opportunity employer.
Salary : $37
