What are the responsibilities and job description for the Utilization Specialist position at Lakeland Behavioral Health System?
Overview
Lakeland Behavioral Health is a leading provider of mental health services located in Springfield, Missouri. The facility specializes in offering comprehensive psychiatric care for children, adolescents, and adults. Their services include inpatient and outpatient treatment programs designed to address a wide range of mental health conditions, such as depression, anxiety, bipolar disorder, and substance use disorders.
Lakeland Behavioral Health is committed to delivering high-quality care through evidence-based practices and a multidisciplinary approach. The facility employs a team of experienced professionals, including psychiatrists, psychologists, nurses, social workers, and therapists, who work collaboratively to create individualized treatment plans for each patient
The Utilization Specialist plays a crucial role in ensuring the efficient use of healthcare resources and maintaining high standards of patient care. This position involves reviewing patient cases to determine the appropriateness of admissions, continued stays, and discharges, as well as managing authorization procurement and mitigating concurrent denials.
Needs to be flexible on hours. Will be 40 hrs per week.
Monday - Friday
Responsibilities
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
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:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- 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.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
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.
LAKE01
#LI-LBHS
