Utilization Review Specialist - LEAD

ESSENTIAL FUNCTIONS:

• Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
• Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
• Evaluate the utilization program for compliance with regulations, policies and procedures.
• Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
• 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. 
• Four or more year's clinical experience with the population of the facility and previous experience in utilization management required.