What are the responsibilities and job description for the UR Specialist (Full Time ) position at Acadia?
Essential Functions
At Crestwyn Behavioral Health, you will have an opportunity to shine in your Utilization Review skills! You will:
At Crestwyn Behavioral Health, you will have an opportunity to shine in your Utilization Review skills! You will:
- 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.
- Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field required.
- Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
- Current clinical professional license or certification, as required, within the state where the facility provides services preferred.
