Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Bachelor's Degree with 1 to 2 years prior drug and alcohol experience is preferred
· 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.
Job Type: Full-time
Pay: $20.00 - $21.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
- Weekends as needed
Experience:
- Utilization review: 1 year (Preferred)
Work Location: In person