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Utilization SpecialistAcadia Healthcare • Danville, California, United States
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Utilization Specialist

Acadia Healthcare
  • US
    Danville, California, United States
  • US
    Danville, California, United States
Apply Now

About

Utilization Specialist

Geisinger Behavioral Health in Danville is looking for a Utilization Specialist to join our growing team!

Purpose Statement:

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

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.

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:

  • Danville, California, United States

Languages

  • English
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