What are the responsibilities and job description for the Utilization Specialist position at Acadia Behavioral Health (Pioneer Behavioral Health)?
Overview
FT Utilization Specialist
Coachella Valley Behavioral Health, Indio CA (near Palm Springs)
Hourly rate range: $32.00 - $36.00 , depending on experience
Coachella Valley Behavioral Health is a NEW, state-of-the-art inpatient facility in Indio, California. We provide clinically excellent treatment for adults who are struggling with mental health concerns and substance use disorders. Located in Indio, California,
Coachella Valley Behavioral Health is the only facility of its kind in the area, and we are proud to provide services for those in need of effective behavioral healthcare.
Coachella Valley Behavioral Health Benefits:
We provide a comprehensive package of benefits. Current benefits include:
- Competitive salary commensurate with experience.
- Brand new facility with endless opportunity for professional development and continued education
- Supportive work environment that values teamwork and collaboration.
- Cutting-edge medical facilities and advanced technologies.
- Opportunities for career growth and advancement.
COMPENSATION
Compensation for roles at Coachella Valley Behavioral Health varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, Coachella Valley Behavioral Health provides a reasonable hourly range of compensation for roles that may be hired in California.
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 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.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education : Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
CVBH
Salary : $32 - $36