Utilization Review Specialist

Posted:
12/5/2024, 2:15:32 AM

Location(s):
Florida, United States ⋅ Fort Myers, Florida, United States ⋅ Arcadia, Florida, United States ⋅ Bradenton, Florida, United States

Experience Level(s):
Junior

Field(s):
Medical, Clinical & Veterinary

Workplace Type:
On-site

Centerstone is among the nation’s leading nonprofit behavioral health systems with thousands of employees dedicated to delivering care that changes people’s lives. A dynamic, well-established organization, we offer rewarding opportunities to serve all ages in a variety of settings. Come talk to us about joining the Centerstone team!


JOB DESCRIPTION:

SUMMARY OF POSITION

Knowledge of utilization review process with the ability to review continued length of stay, assure appropriate allocation of facility resources by striving to provide quality client care in the most cost-effective manner.  Monitor chart quality of representative sample of Crisis Stabilization Unit charts.

 ESSENTIAL DUTIES & RESPONSIBILITIES

  • Reports to work as scheduled on a daily basis and performs assigned duties to ensure the smooth operation of the department.

  • Performs utilization and financial case management.

  • Maintains a clear description of methodology used in conducting utilization review/financial case management role.

  • Assures proper information is relayed to third party provider in timely fashion.

  • Assures continued need for stay is documented.

  • Meets appropriate deadlines for certification and recertification.

  • Documents activities for later review.

  • Assures appropriate consents are signed for information release and maintains confidentiality policies.

  • Makes Clinical Director, UR Coordinator aware of client/payor issues.

  • Communicates effectively with treatment team including psychiatrist to ensure appropriate length of stay.

  • Train Case Managers.

  • Function as team leader for other UR positions, giving guidance and training. 

  • Coordinate flow of information between UR, units, and fiscal staff.

KNOWLEDGE, SKILLS & ABILITIES

  • Effectively communicate via written, verbal, in person and virtual methods.

QUALIFICATIONS

         

Education Level              

Bachelor’s Degree required.

Years of Experience       

Two years’ behavioral health experience required.

Certification/Licensure 

N/A

PHYSICAL REQUIREMENTS

Standing – 20%

Sitting – 80%

Squatting – Occasional

Kneeling – Occasional

Bending – Occasional

Driving – Occasional

Lifting (up to 20 lbs) – Occasional

DISCLAIMER

The duties and responsibilities described in this document are not a comprehensive list and additional tasks may be assigned to the employee from time to time, or the scope of the job may change as necessitated by business demands.

Time Type:

Full time

Pay Range:

$17.35--$24.30

Delivering care that changes people's lives starts with our employees. Below are just some of the great benefits Centerstone employees enjoy:

  • Medical, dental, and vision health coverage
  • Flexible Spending and Health Savings Accounts
  • 403b retirement plan with company match
  • Paid time off and ten paid holidays
  • AD&D Insurance, Life Insurance, and Long Term Disability (company paid)
  • Diversity, Equity, and Inclusion employee resource groups
  • Continuing education opportunities
  • Employee Assistance Program

Centerstone is an equal opportunity employer. Employment at Centerstone is based solely on a person's merit and qualifications directly related to professional competence. Centerstone does not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), or any other basis protected by law.

At Centerstone, we use our values as a guide for what we do. Respect, Expertise, Integrity and Empowerment are at the heart of every interaction at Centerstone, and particularly rooted in our beliefs toward diversity and inclusion.

Our approach to diversity is simple—it’s about embracing everyone. Together, we continue to develop an inclusive culture that encourages, supports and celebrates the diverse voices and experiences of our employees. It powers our innovation and connects us closer to each other, to our clients and the communities we serve. We strive to create a workplace that reflects the growing world around us, and where everyone feels empowered, safe and welcomed.

Centerstone is also committed to a strong culture of quality and safety, celebrating role-models who champion best practices for quality, clinical risk, and patient safety.