What are the responsibilities and job description for the Utilization Specialist position at Galax Treatment Center?
We offer a full suite of benefits ranging from:
- Competitive hourly rates
- Medical, Dental, and Vision Insurance
- Paid Holidays
- Paid Time Off
- HSA & FSA
- Company Paid Basic Life & AD&D
- Disability
- 401(k) Retirement Plan - with company match
- Employee Assistance Program/Employee Discount Program
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.
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.
Experience
Preferred- 2 year(s): Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
Education
Required- High School/GED or better
- Associates or better in Nursing/Healthcare or related field
Skills
Preferred- Planning & Organizing
- Written Communication
- Attention to Detail
Behaviors
Preferred- Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
