Utilization Review Specialist PRN

Job description

Pacific Grove Hospital, is a nationally recognized 68 bed acute psychiatric and chemical dependency treatment center offering inpatient & outpatient services for psychiatric illnesses, addictions & co-occurring disorders. Our hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. Utilization Review Specialist duties include: 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 r...