Utilization Review Specialist

Job description

Come join our team as a Utilization Review Specialist! At Signature Psychiatric Hospital, our mission is to heal lives with our Signature touch. By meeting each patient where they are on their journey toward better health, we can provide hope that more fulfilling days are just around the corner.

About Us:

Located in Kansas City, Missouri, Signature Psychiatric Hospital is the preferred provider of acute inpatient and outpatient treatment for adolescents, adults, and senior adults who are struggling with mental health concerns and substance use disorders.

Essential Functions as a Utilization Review Specialist:

• 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.

Schedule/Available Shifts:

We have daily shifts that allow our employees to have stable schedules and enjoy quality time away from the facility. Shifts are 8 hours from 8:00 AM - 4:30 PM Monday - Friday, allowing you to enjoy a great work/life balance.

We have flexible hours available for Full time, Part time, or PRN, both day and night shifts.

Benefits of Joining Our Team:

• Competitive hourly rates
• Medical, Dental, and Vision Insurance
• Paid Holidays
• Paid Time Off
• HSA & FSA
• Company Paid Basic Life & AD&D
• Disability
• 401(k) Retirement Plan - with company match
• Employee Assistance Program/Employee Discount Program

Job 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/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.

Job Type: Full-time

Pay: $19.00 - $37.00 per hour

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Liberty, MO 64068: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Required)

Experience:

• Utilization management: 2 years (Required)

License/Certification:

• LMSW (Required)
• RN License (Required)

Work Location: One location