Utilization Review Specialist (Funding Liaison)

*ESSENTIAL FUNCTIONS:* · Act as liaison between managed care organizations and the facility professional clinical staff.
· Need for detail, multi-tasking skills, and to be customer service orientated.
- 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:* · Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
*LICENSES/DESIGNATIONS/CERTIFICATIONS:* · 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: From $15.
00 per hour Benefits: * 401(k) * 401(k) matching * Dental insurance * Employee assistance program * Flexible spending account * Health insurance * Life insurance * Paid time off * Tuition reimbursement * Vision insurance Schedule: * 8 hour shift * Day shift * Monday to Friday Ability to commute/relocate: * Allenwood, PA 17810: Reliably commute or planning to relocate before starting work (Required) Experience: * Medical records: 1 year (Preferred) Work Location: In person