Utilization Review Specialist (Rn)

Riverview Behavioral Health searching for a Utilization Review Specialist to join our team!

Riverview is the premier psychiatric center in Texarkana, Arkansas, where children, adolescents, and adults can receive comprehensive inpatient help for the mental health challenges that have disrupted their lives. We are a 62-bed psychiatric hospital that is dedicated to providing high-quality care for adults, geriatrics, and adolescents (ages 11-17) who are suffering from behavioral health and chemical dependency issues.

Riverview Behavioral Health is part of the Acadia Healthcare system, a provider of addiction, behavioral and mental health treatment facilities in the United States, United Kingdom and Puerto Rico.

BENEFITS:

Riverview Behavioral Health provides a comprehensive package of benefits. Current benefits include:

• Competitive hourly rate

• Medical, dental, and vision insurance

• Acadia Healthcare 401(k) plan

• Excellent training program

• Professional growth opportunity that is second to none in the industry. Join a team with defined career paths and a national family of hospitals and facilities as part of the Acadia Healthcare family

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.

SCHEDULE:

• Full-Time Days Monday

• Friday 8am

• 5pm

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:

• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I 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.

• 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.