What are the responsibilities and job description for the UM Specialist position at NewVista Healthcare?
UM Specialist.
Shift: M-Fr 8-5
Who we are
At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.
The Role Itself
Position Summary: The Utilization Management Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeal. The UM Specialist will accurately report the authorization status of patients, denials and appeals status to the Corporate Director of UM. The UM Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.
- Oversees the request for services including the determination of appropriate level of care, initial authorization, the concurrent review process and appropriate discharge notification.
- Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
- Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care.
- Oversees the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals.
- Maintains logs of all denials along with updated status of same.
- Reports status of high risk cases such as limited benefits, peer reviews, denials or unplanned discharges.
- Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
Job Requirements:
- Bachelors Degree in Nursing, Social Work, or related field preferred
- Prior exp in UR in a similar role within a healthcare setting.
- LPN, RN, LSW, LPC are applicable licenses for this role.
Perks at Work
Healthcare:
- Medical Packages with Rx – 3 Choices
- Flexible Spending Accounts (FSA)
- Dependent Day Care Spending Accounts
- Health Spending Accounts (HSA) with a company match
- Dental Care Program – 2 choices
- Vision Plan
- Life Insurance Options
- Accidental Insurances
- Paid Time Off Paid Holidays
- Employee Assistance Programs
- 401k with a Company Match
Education Leadership Development
- Up to $15,000 in Tuition Reimbursements
- Student Loan Forgiveness Programs
Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.
