New

Utilization Specialist

Acadia Pharmaceuticals Inc.
vision insurance, paid time off, paid holidays, 401(k), retirement plan, employee discount
United States, Virginia, Galax
Jan 29, 2025
Come join our team as a Utilization Specialist, at the Life Center of Galax-Hillsville! We are looking for individuals who are passionate about behavioral health. If you are interested in growth opportunities that are second to none in the industry and making a difference in the lives of people in our community, this position is right for you! Proactively monitor utilization of services for patients to optimize reimbursement for the facility. We offer a full suite of benefits ranging from: * Competitive hourly rates * Medical, Dental, and Vision Insurance * Paid Holidays * Paid Time Off * HSA & FSA * Company Paid Basic Life & AD&D * Disability * 401(k) Retirement Plan - with company match * Employee Assistance Program/Employee Discount Program 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. 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 experiencein utilization management preferred. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)