Utilization Review Specialist at Geisinger Behavioral Health Center Danville, Fayetteville, AR
Utilization Review Specialist at Geisinger Behavioral Health Center Danville in Fayetteville, AR. Full-time. Est. up to $130k. Apply with swipeandhired.
Vantage Point Behavioral Health
Overview
Vantage Point Behavioral Health Hospital is seeking a Full Time Utilization Review Specialist at our Fayetteville, AR location.
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
- 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.
Responsibilities
ESSENTIAL FUNCTIONS:
- 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:
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