Utilization Review Specialist

Camp Recovery Riverdale , GA 30274

Posted 2 months ago

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility's 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.

Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients.

Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients.

Facilitate peer review calls between facility and external organizations.

Act in coordination with the leadership team of the facility or corporate office to improve the quality of services provided within the organization.

Assist the admissions department with pre-certifications of care.

Initiate and complete the formal appeal process for denied admissions or continued stay.

Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

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.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Licensed LPN or RN, or Associate's Degree, Bachelor's Degree in Social Work, behavioral or mental health, nursing or other related health field; Master's degree in social work, counseling, nursing or related health field preferred. 2+ years' experience with the population of the facility and previous experience in utilization management preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Current licensure as an LPN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Certified Therapeutic Recreation Specialist

Camp Recovery

Posted 1 month ago

VIEW JOBS 9/19/2020 12:00:00 AM 2020-12-18T00:00 PURPOSE STATEMENT: Responsible for planning, developing, directing and coordinating a program of activity therapies in a facility, collaborating with medical staff and heads of professional departments to eliminate conflicts with other treatment programs. ESSENTIAL FUNCTIONS: Plan, develop and coordinate the overall program of activity therapies, including occupational, music and recreational therapy, with other activities. Serve on administrative committees. Recommend policies and procedures for activity therapy programs. Plan and conduct staff development and training programs for professional and nonprofessional therapy personnel. Screen candidates for programs and place in the programs best suited to individual needs. Conduct regular staff meetings on therapeutic programs. Direct and supervise professional personnel in their conduct of musical, recreational, occupational and industrial therapy programs. Coordinate the various therapy programs with other services to comply with industry and facility policies. Responsible for the requisition of materials, supplies and equipment necessary to the effective operation of the therapy programs and corresponding budgets. Prepare reports as required. Appear before various external professional groups to interpret and explain the objectives of the therapeutic programs of the facility. Carry caseload and supervise staff for licensure. OTHER FUNCTIONS: Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: Bachelor's degree in Recreational Therapy or other recreation-based field which may be approved for national certification in their area of expertise. Master's degree preferred in some facilities, based on state requirements. Four or more years' professional level experience working with the specialty/service of the facility. One or more years of supervisory experience. LICENSES/DESIGNATIONS/CERTIFICATIONS: May require licensure, Certified Therapeutic Recreation Specialist (CTRS) or currently in the process of obtaining national certification, depending on state requirements. First Aid, CPR, de-escalation and restraint certification required (training available upon hire and offered by facility). ADDITIONAL REGULATORY REQUIREMENTS: Click here to enter text. 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. Camp Recovery Riverdale GA

Utilization Review Specialist

Camp Recovery