Acadia Healthcare Utilization Review Specialist in Riverside, California
Medical, Dental, And Vision Insurance
Acadia 401K Plan
8 Paid Holiday, Personal Time, Sick time
Opportunity for growth
ESSENTIAL FUNCTIONS: LVN License required
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.
Compensation for roles at Pacific Grove Hospital varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, Pacific Grove provides a reasonable hourly range of compensation for roles that may be hired in as set forth below.
Hourly Range 25.00 - 37.47
Planning & Organizing: Intermediate
Problem Solving: Advanced
Attention to Detail: Advanced
Team Player: Works well as a member of a group
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Dedicated: Devoted to a task or purpose with loyalty or integrity
Self-Starter: Inspired to perform without outside help
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
- Associates or better in Nursing/Healthcare
Licenses & Certifications
Lic Vocational Nurse
Lic Practical Nurse
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)