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SalaryBronson offers competitive pay and many other great benefits:
- Three Medical Plan Levels, Dental and Vision Insurance
- HSA with a Company Contribution
- FSA Dependent Care Flexible Spending Account
- Basic Life/AD&D and Supplemental Life Insurance
- Short-Term and Long-Term Disability Insurance
- 401k with a Company Match
- EAP (Employee Assistance Program)
- Employee Discount Program
- Generous PTO, Sick Time, Paid Holidays, and Professional Development Reimbursement
Utilization Review Specialist Job Responsibilities:
- 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.
Education/Experience/Skill Requirements:
- Associate degree in nursing (LPN or RN) required. Bachelor's or master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
- Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
Licenses/Designations/Certifications:
- Current licensure as an LPN or RN 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.
