- 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.
- Perform other functions and tasks as assigned.
- 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.
- 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.
-
Utilization Review Specialist
4 days ago
Acadia Healthcare Inc. Wesley Chapel, United StatesOverview · Shift: 7am - 3:30pm · PURPOSE STATEMENT: · Proactively monitor utilization of services for patients to optimize reimbursement for the facility. · Responsibilities · ESSENTIAL FUNCTIONS: · * Act as liaison between managed care organizations and the facility professional ...
-
Nuclear Medicine Tech PRN
2 weeks ago
Adventist Health System Wesley Chapel, United StatesAll the benefits and perks you need for you and your family: · * Career Development · * Whole Person Wellbeing Resources · * Mental Health Resources and Support · Our promise to you: · Joining AdventHealth is about being part of something bigger. It's about belonging to a communi ...
-
Cardiac Catheterization Tech
4 days ago
AdventHealth Wesley Chapel, United States**All the benefits and perks you need for you and your family:** · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · **Our promise to you:** · Joining AdventHealth is about b ...
-
Nuclear Medicine Tech PRN
4 days ago
AdventHealth Wesley Chapel, United States**All the benefits and perks you need for you and your family:** · - Career Development · - Whole Person Wellbeing Resources · - Mental Health Resources and Support · **Our promise to you:** · Joining AdventHealth is about being part of something bigger. It's about belonging to a ...
-
RN House Supervisor Nights
1 week ago
AdventHealth Wesley Chapel, United States**All the benefits and perks you need for you and your family:** · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · **Our promise to you:** · Joining AdventHealth is about b ...
-
Registered Nurse Care Manager
1 week ago
AdventHealth Wesley Chapel, United StatesAll the benefits and perks you need for you and your family: · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · Our promise to you: · Joining AdventHealth is about being par ...
-
Merchandise Operations Specialist
1 week ago
Petco Wesley Chapel, United States**Merchandise Operations Specialist** · Category: Stores · Location: 1231 Bruce B Downs Blvd, Wesley Chapel , FL 33543 · Schedule: Part_time · **Purpose Statement** · Responsible for the efficient execution of merchandising to ensure consistency with product sets and signage ...
-
lpn
1 day ago
Metro Inclusive Health Wesley Chapel, United StatesStatement of Purpose: This position will be based in Metro Inclusive Health's Hillsborough or Pinellas locations, working in a unique community based setting where we are providing Primary Care and additional supportive services. This position provides direct nursing services and ...
-
lpn
4 days ago
Metro Inclusive Health Wesley Chapel, United StatesStatement of Purpose: This position will be based in Metro Inclusive Health's Hillsborough locations, working in a unique community based setting where we are providing Primary Care and additional supportive services. This position provides direct nursing services and procedures ...
-
lpn
4 days ago
Metro Inclusive Health Wesley Chapel, United StatesStatement of Purpose: This position will be based in Metro Inclusive Health's Hillsborough locations, working in a unique community based setting where we are providing Primary Care and additional supportive services. This position provides direct nursing services and procedures ...
-
consumer access manager
1 week ago
AdventHealth Zephyrhills, FL , USA, United States**All the benefits and perks you need for you and your family:** · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · **Our promise to you:** · Joining AdventHealth is about b ...
-
Supply Chain Specialist Coordinator
5 days ago
AdventHealth Wesley Chapel, United StatesAll the benefits and perks you need for you and your family: · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · Our promise to you: · Joining AdventHealth is about be ...
-
Nuclear Medicine Tech PRN
2 weeks ago
AdventHealth Wesley Chapel, United StatesAll the benefits and perks you need for you and your family: · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · Our promise to you: · Joining AdventHealth is about being part of something bigger. It's about belonging to a community tha ...
-
Supply Chain Specialist Coordinator
1 week ago
AdventHealth Wesley Chapel, United StatesAll the benefits and perks you need for you and your family: · Paid Days Off from Day One · Student Loan Repayment Program · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support · Our promise to you: · Joining AdventHealth is about being par ...
-
Registration Specialist
3 days ago
University of Miami Coral Gables, United StatesCurrent Employees: · If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here $) to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please re ...
-
Credit and Collections Specialist
1 day ago
Insight Global Pembroke Pines, United StatesOne of Insight Global's clients is seeking a Credit and Collections Specialist to their team in Miramar, Florida. As a Credit and Collections Specialist, you will be responsible for tasks such as customer onboarding, reviewing credit applications, cleaning up aged accounts, and p ...
-
Lead AP Specialist
2 weeks ago
Insight Global Pembroke Pines, United StatesProcessing and resolution · -Routing out invoices to end user, following up with end user · Advanced AP specialist · We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal ...
-
University of Miami Coral Gables, United StatesCurrent Employees: · If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here $) to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please re ...
-
Sr Research Associate 1
3 days ago
University of Miami Coral Gables, United StatesCurrent Employees: · If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here $) to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please re ...
-
Care Coordinator
2 weeks ago
MedElite LLC Pembroke Pines, United StatesAbout MedElite:MedElite provides innovative solutions for skilled nursing facilities by partnering with the long-term care providers and clinicians for the benefit of not only the facilities, but also the specialists and most importantly, the patients. MedElite's vision is to rev ...
Utilization Review Specialist - Wesley Chapel, United States - North Tampa Behavioral Health
Description
Overview:
Shift: 7am - 3:30pm
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities:ESSENTIAL FUNCTIONS:
OTHER FUNCTIONS:
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
LICENSES/DESIGNATIONS/CERTIFICATIONS:
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individuals characteristics protected by applicable state, federal and local laws.
URSPECF