Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and service quality
- Ongoing support and training for staff on documentation and medical necessity updates
- Work closely with clinical staff and managed care organizations to optimize reimbursement

What to Expect (Job Responsibilities):
- Act as a liaison between managed care organizations and the facility's professional clinical staff
- Conduct reviews of insurance plans or managed care organizations and coordinate communication regarding reimbursement requirements
- Monitor patient length of stay and inform clinical staff about issues that may impact it
- Gather and develop statistical and narrative information for reporting on utilization and quality of services
- Facilitate peer review calls and assist with the formal appeal process for denied admissions or continued stays

What is Required (Qualifications):
- High school diploma or equivalent required
- Clinical experience is required, or two or more years of experience working with the facility's population
- Preferred education includes an Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field
- CPR and de-escalation and restraint certification required (training available upon hire)
- Preferred licensure includes LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services

How to Stand Out (Preferred Qualifications):
- Previous experience in utilization management is preferred
- Current clinical professional license or certification, as required, within the state where the facility provides services
- First aid certification may be required based on state or facility requirements

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