Sierra Tucson is seeking a Utilization Specialist!

Sierra Tucson is seeking a Utilization Specialist! Sierra Tucson - 2.7 Tucson, AZ Job Details Full-time 2 days ago Benefits Health savings account AD&D insurance Paid holidays Disability insurance Health insurance Dental insurance Flexible spending account Paid time off Employee assistance program Career development plan Vision insurance 401(k) matching Employee discount Professional development assistance Life insurance Qualifications CPR Certification BLS Certification High school diploma or

GED Full Job Description Overview:

PURPOSE STATEMENT

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. About Sierra Tucson For 40 years, Sierra Tucson has been a place of peace, hope, and healing. On our serene 160-acre campus located at 39580 S. Lago Del Oro Pkwy. Tucson, AZ 85739, experienced professionals provide integrative, evidence-based care to help adults of all genders achieve lasting recovery from addiction and mental illness. Sierra Tucson is accredited by the Joint Commission and dual licensed as both an Inpatient Behavioral Health Unit and Residential Treatment Center. Benefits of joining our team Three medical plan levels, dental and vision insurance HSA, FSA, Dependent Care Flexible Spending Account Basic Life/AD&D and Supplemental Life Insurance Company paid short term disability insurance Optional long term disability insurance 401k with Company match EAP (Employee Assistance Program) Employee Discount Program Generous PTO, Sick Time, paid holidays Professional development reimbursement

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

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.

ADDITIONAL REGULATORY REQUIREMENTS

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from par ticular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 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. STU01