Part Time Utilization Specialist at ECU Health Behavioral Health Hospital, Germantown, TN

Part Time Utilization Specialist at ECU Health Behavioral Health Hospital in Germantown, TN. Part-time. Est. up to $80k. Apply with swipeandhired.

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ​ 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 extension s and i nform 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. Qualifications ​ EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: ​ Required Education: High school diploma or equivalent.</s