Utilization Management Specialist
Full Time
Knoxville, TN 37909
Posted
Job description
BENEFITS:
- Competitive salary
- Medical, dental, and vision insurance
- Employee Discount Program
- Employee Assistance Program
- 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
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.
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