You’ll need
Licensure
✓or current clinical professional license or certification, as required, within the state where the facility provides services.
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
✓LVN/LPN, RN, LMSW, LCSW, LPC, LPC-A within the state where the facility provides services
✓First aid may be required based on state or facility requirements.
About the role
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.