Job Information
Acadia Healthcare Utilization Review Specialist in Wichita Falls, Texas
Description
Description
Red River Hospital is the leading provider of inpatient and outpatient behavioral healthcare in Wichita Falls, TX. Our treatment services & specialized programs address drug and alcohol addiction and co-occurring mental illness.
Red River Hospital has been a leader in behavioral healthcare for over 40 years, providing superior healthcare treatment to the people, communities, and military installations we serve. We are a private inpatient 96 bed acute psychiatric facility dedicated to the treatment of behavioral health and substance abuse services. Located in Wichita Falls, Texas, Red River Hospital provides mental health and substance abuse treatment to the following populations:
Dedicated military personnel
Adults
Seniors
Adolescents (ages 12 through 17)
Our excellent staff is committed to the continuous improvement of behavioral healthcare by providing treatment opportunities that promote individual, family, and community wellness. As a team, we are dedicated to providing high quality, outstanding care and attending to the individual needs of each patient and their family in a caring and compassionate manner.
Serving Northern Texas and Southern Oklahoma
Our location in Wichita Falls allows for convenient access to residents of nearby Texas cities like Burkburnett as well as South Oklahoma cities like Lawton. Call the number below to begin the process of healing.
Mission, Vision & Values
Mission: To bring light into the lives of our patients and their families, to inspire hope through supportive, individualized care, and to serve our community by setting the standard for excellence in the treatment of mental health and addiction concerns.
Vision: To be the behavioral healthcare provider and employer of choice.
Values: Respect, Empathy, Dedication
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 facility.
First aid may be required based on state or facility requirements.
Qualifications
Skills
Required
Problem Solving: Advanced
Financial Awareness: Intermediate
Planning & Organizing: Advanced
Negotiating: Expert
Customer Focus: Advanced
Communication: Advanced
Attention to Detail: Advanced
Behaviors
Required
Thought Provoking: Capable of making others think deeply on a subject
Team Player: Works well as a member of a group
Innovative: Consistently introduces new ideas and demonstrates original thinking
Loyal: Shows firm and constant support to a cause
Enthusiastic: Shows intense and eager enjoyment and interest
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
Motivations
Required
Self-Starter: Inspired to perform without outside help
Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
Goal Completion: Inspired to perform well by the completion of tasks
Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Education
Required
Bachelors or better in Counseling
Associates or better in Nursing/Healthcare
Preferred
Masters or better in Counseling
Bachelors or better in Nursing/Healthcare
Licenses & Certifications
Required
Lic Bachelor Social Wkr
Lic Vocational Nurse
Preferred
Lic Marriage Family Thera
Lic Clin Social Wkr
Lic Master's Social Wkr
Lic Prof Counselor
Reg Nurse
Experience
Preferred
- 2 years: Utilization Management in Behavioral Health
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)