Calistoga, California, USA
10 days ago
Utilization Review Specialist

BENEFITS Include:

Duffy's Napa Valley Rehab provides a comprehensive package of benefits for our employees. Current benefits include:

Medical, dental, and vision insurance Acadia Healthcare 401(k) plan Paid Time Off accruals - vacation, sick, personal days Employee Assistance Program (EAP) Professional growth opportunities. Join a team with defined career paths and a national family of facilities

ESSENTIAL FUNCTIONS Include:

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.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

 

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Associate's degree 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.

Compensation for roles at Duffy’s Rehab 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, Duffy’s Rehab provides a reasonable hourly range of compensation for roles that may be hired in California set forth below.

Role Location: Calistoga, California

Calculated Hourly Range for role:
California: $26 -$29 per hour

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