Utilization Review Specialist Job at Ascension St. Thomas Behavioral Health
Ascension Saint Thomas Behavioral Health Hospital is seeking a skilled UR Specialist to join our team of professionals. As Nashville’s leading behavioral health hospital, we provide a full continuum of behavioral health treatment services for adults and seniors. Our goal is to deliver compassionate, personalized care to those who turn to us in their time of need.
ESSENTIAL FUNCTIONS:
- 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.
- Facilitate peer review calls between facility and external organizations.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- 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.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Education:
- Bachelor's (Required)
Experience:
- Utilization management: 1 year (Required)
Work Location: One location
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