Overview
Utilization Specialist Opportunity (8 hours shifts) at The Camp Recovery Center – Scotts Valley, CA
Pay Range $25.00 - $27.00
We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley. This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.
Medi-Cal Experience and Understanding Preferred
Responsibilities
ESSENTIAL FUNCTIONS:
- 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.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
- UM Experience preferred
- Medi-Cal experience and understanding preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I 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.
COMPENSATION:
Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.
Role Location: CALIFORNIA
Calculated Hourly Range for role Utilization Specialist
State – California: $25.00 - $27.00
BENEFITS: For Full Time Staff only
The Camp Recovery Center provides a comprehensive package of benefits for our Full Time Utilization Specialist. Current benefits include:
- Competitive hourly rate
- Shift differential for overnight shifts
- Medical, dental, and vision insurance
- Acadia Healthcare 401(k) plan
- Excellent training program
- Complimentary AOD Education to certify as a Substance Use Disorder Counselor
- Professional growth opportunity that is second to none in the industry.
AVAILABILITY AND HOURS:
This is a Full-Time EMT position Monday - Friday. Shifts are 8 hours, and are overtime eligible.
ADDITIONAL REGULATORY REQUIREMENTS:
As Needed
Equal Employment Opportunity: We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
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