Utilization Review Specialist | Wooded Glen Recovery Center | Henryville, Indiana

About the Job:

**ON SITE POSITION**

PURPOSE STATEMENT:

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.

Roles and Responsibilities:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• High School diploma or equivalent required. Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a substance abuse setting required and ASAM experience preferred.
• At least one year experience in utilization review preferred.
  
  
  

What we offer:

Make A Meaningful Impact

• Be a part of a team that directly contributes to changing lives and helping individuals reclaim their future.
  
  
  

Growth & Development

• Our commitment to your professional growth is reflected in our provision of FREE and accessible continuing education courses, ongoing training programs and workshops to enhance your professional skills
• Opportunities for career advancement within the organization
  
  
  

Collaborative Culture

• Work in an environment that fosters teamwork, inclusivity, and open communication
• Team building activities and events to strengthen relationships
  
  
  

Health And Wellness Benefits

• Comprehensive healthcare package including medical, dental, and vision coverage
  
  
  

Competitive Compensation

• Competitive salaries to reward your dedication and hard work
• FREE Employee discount programs, FlexPay program (your paycheck funds when you need them) and employee assistance programs (legal, financial, etc)
• Toll reimbursement program for Kentucky residents!
  
  
  

Diversity and Inclusion

• A commitment to creating a diverse and inclusive workplace where everyone feels valued and respected
• Beautiful, scenic setting on 500+ acres
  
  
  

Employee Recognition

• Regular employee recognition events to celebrate achievements and milestones.
  
  
  

ESSENTIAL FUNCTIONS:

• Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes client’s condition and need for hospitalization.
• Communicates directly with physicians and other providers with respect to specific inquires and perceived trends of issues as they relate to utilization management.
• Appeals all denials ensuring accuracy of information and effective coordination of correspondence. Initiates, coordinates, and monitors the appeal process. Provides information to physicians to assist them in their role in appeals.
• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Maintains accurate documentation and files as it relates to utilization management.
• Provides ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each instance to determine if corrective action was taken. Notifies supervisor if corrective action is not completed.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Monitors client length of stay and extensions and informs clinical and medical staff on issues that may impact length of stay. Investigates short term length of stays and endeavor to create alternate financial planning which would offer the client extended days of treatment. Participates in discharge planning as required.
• Gathers and develops 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.
• Conducts quality reviews for medical necessity and services provided. Facilitates peer review calls between facility and external organizations. Identifies potential review problems and discuss them with multi-disciplinary team and/or administration.
• Acts as liaison between managed care organizations and the facility professional clinical staff.
• Assists with any problems encountered during on-site or telephone reviews by the third-party payers or review organization, when necessary.
  
  
  

We seek talented, qualified employees regardless of race, color, sex/gender, including pregnancy, gender identity and expression, national origin, religion, sexual orientation, disability, age, marital status, citizen status, veteran status, or any other protected classification under country or local law. We are proud to be an Equal Employment Opportunity Employer.

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Thank you for your interest in joining our team! To learn more about us, please visit our website at https://woodedglen.com/

• Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served. Why Wooded Glen Recovery Center?Wooded Glen Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Wooded Glen Recovery Center is an EOE.
  
  
  

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.