Job description

The Utilization Review Specialist is an essential role at Mount Carmel Behavioral Health, an 80-bed inpatient acute treatment center for adult men and women who have been/currently are experiencing a wide range of mental or behavioral health challenges. The Utilization Review Specialist at Mount Carmel Behavioral Health, a joint partnership between Acadia Healthcare and Mount Carmel Health Systems, will serve as a partner to the UM department and other departments through the facility as a bridge between impacting direct patient care and financial stability of the facility.

Essential Functions include but not limited to:

• Act as liaison between managed care organizations and the facility’s 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.
• Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients.
• Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients.
• Facilitate peer review calls between facility and external organizations, as well assist the admissions department with pre-certifications of care.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• 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.

Educational/Licensure/Skills Requirements:

• Current and valid Licensed LPN in state of Ohio required
• Associate's Degree in Nursing OR Bachelor's Degree in Social Work, behavioral or mental health required. Master's degree in social work preferred.
• Two (2) plus years' experience with the population of the facility and previous experience in utilization management required.
• CPR/First Aid and De-escalation certifications required.

Job Type: Full-time

Pay: $18.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

COVID-19 considerations:
All employees are required to wear a mask at all times. Patients are encouraged.

Education:

• Associate (Required)

License/Certification:

• LPN (Preferred)
• CPR Certification (Required)
• First Aid Certification (Required)

Work Location: One location

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