Registered Nurse (RN) - Utilization Review
Acadia Healthcare Inc
Chicago, IL
Sign-On Bonus

Utilization Review Specialist

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: * Associate's 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. * CPR and de-escalation and restraint certification required (training available upon hire and offered by the facility.