Oasis Behavioral Health

Chandler, AZ

Utilization Review Specialist (UR Coordinator)

Posted over 1 month ago

Job Description

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 Masters 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.
89072971

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