Utilization Review Manager - Home Care jobs in Tampa, FL

Are you prepared for the impact you can make in your career at a well-respected treatment center in Brooksville, Florida? If so, you may enjoy working at Sabal Palms Recovery Center, an addiction treatment facility nestled on a 10-acre campus located along Florida's Nature Coast and surrounded by live oak trees. Sabal Palms Recovery Center provides premier residential treatment for adults age 18 and older who are struggling with addictions.

Our skilled professionals are focused on sharing their knowledge and expertise to help you get acclimated to your new role. Along with detailed training and continual support, our staff will give you the autonomy you need to achieve your career goals. You will love working to make a difference in the lives of our patients as you collaborate with other professionals and a supportive management team.

Sabal Palms is looking to hire a part time Utilization Review Specialist. The role of our UR Specialist is to proactively monitor utilization of services for patients to optimize reimbursement for the facility.

If this sounds like the place for you, contact us today.

RESPONSIBILITIES:

• 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.

BENEFITS:

Twelve Oaks provides a comprehensive package of benefits for all Full-Time and Part-Time Benefit Eligible employees. Current benefits include:

• Acadia Healthcare 401(k) plan
• General Paid Time off to include: Vacation, Sick, Personal Days, and Extended Sick Leave
• Excellent training program
• Professional growth opportunity that is second to none in the industry. Join a team with defined career paths and a national family of hospitals and facilities.

Education

• Associates or better in Nursing/Healthcare or related field