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Acadia Healthcare · Seven Hills Hospital · Henderson, NV

Utilization Specialist

Experience2+ yrs
EducationHS diploma
PostedOct 21
✓You’ll need
Licensure
✓Current clinical professional license or certification, as required, within the state where the facility provides services.
LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services preferred
Certifications
✓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.
✓Assist the admissions department with pre-certifications of care .
✓CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
Education
✓High school diploma or equivalent.
Associate's, Bachelor's, or M aster’s degree in S ocial W ork , B ehavioral or M ental H ealth, N ursing, or a related health field. preferred
Qualifications
✓Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
✓First aid may be required based on state or facility requirements.
Acadia Healthcare
1,512open roles
8hospitals roles open at this facility
20 miHenderson to Las Vegas
All 1,512 Acadia jobs
Want the next hospitals job in Nevada by email?
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✓You’ll need
Licensure
✓Current clinical professional license or certification, as required, within the state where the facility provides services.
LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services preferred
Certifications
✓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.
✓Assist the admissions department with pre-certifications of care .
✓CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
Education
✓High school diploma or equivalent.
Associate's, Bachelor's, or M aster’s degree in S ocial W ork , B ehavioral or M ental H ealth, N ursing, or a related health field. preferred
Qualifications
✓Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
✓First aid may be required based on state or facility requirements.
Acadia Healthcare
1,512open roles
8hospitals roles open at this facility
20 miHenderson to Las Vegas
All 1,512 Acadia jobs
Want the next hospitals job in Nevada by email?
Weekly, free, unsubscribe with one click.

Full employer posting

​ PURPOSE STATEMENT: ​ Proactively monitor utilization of services for patients to optimize reimbursement for the facility . ​

​ 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

​ Required

High school diploma or equivalent. ​ Preferred

Associate's, Bachelor's, or M aster’s degree in S ocial W ork , B ehavioral or M ental H ealth, N ursing, or a related health field. ​

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

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

​ ​ 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.

About the role

Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay. Conduct quality reviews for medical necessity and services provided. Assist the admissions department with pre-certifications of care .