Oasis Behavioral Health

Tucson, Arizona, United States

Utilization Review / Title 36 Specialist - Inpatient

Posted over 1 month ago

Job Description

Sonora is the Leading Behavioral Health Hospital in Tucson, Arizona.
We are looking to expand our Utilization Review Team! The Utilization Review/Title 36 Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility, and prepare Title 36 documents for submission to courts and payors. The successful candidate will have least two years experience in behavioral health; Title 36 and utilization management experience preferred.

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.
  • Prepare documents/packets for submission to courts.
  • 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.

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