Utilization Review Specialist

Burkwood Treatment Center is seeking a Utilization Review Specialist who is responsible for monitoring utilization of services for patients to optimize reimbursement for the facility from Insurance providers. 

ESSENTIAL JOB FUNCTIONS:

• Act as liaison between Insurance providers and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations.
• 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.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Provide case management and care coordination services for clients/patients/residents in the facility.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Bachelor’s degree in Social Work, Counseling or related human service field required.
• One or more years’ experience working in a behavioral health setting preferred.
• Previous experience with the substance abuse population preferred.
• Previous experience in case management and/or utilization review preferred.

OUR BENEFITS:

• Medical, Dental, Vison insurance.
• Acadia Healthcare 401(k) plan & match.
• Paid vacation and sick time.
• Employee Assistance Program
• Employee Disaster Relief
• Opportunity for growth that is second to none in the industry.