Utilization Specialist - Acute
Summit BHC
- # Utilization Specialist - AcuteApplylocations: The Pavilion at Williamsburg Placetime type: Full timeposted on: Posted Todayjob requisition id: JR125591Utilization Specialist - Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia**About the Job:**The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.**Roles and Responsibilities:**· Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes patient’s condition and need for hospitalization.· Communicates directly with physicians and other providers with respect to specific inquires and perceived trends of issues as they relate to utilization management.· Appeals all denials ensuring accuracy of information and effective coordination of correspondence. Initiates, coordinates, and monitors the appeal process. Provides information to physicians to assist them in their role in appeals.· Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.· Maintains accurate documentation and files as it relates to utilization management.· Provides ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.· Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each instance to determine if corrective action was taken. Notifies supervisor if corrective action is not completed.· Coordinates information and findings with the business office to help recognize or resolve possible payment problems.· Monitors patient length of stay and extensions and informs clinical and medical staff on issues that may impact length of stay. Investigates short term length of stays and endeavor to create alternate financial planning which would offer the patient extended days of treatment. Participates in discharge planning as required.· Gathers and develops 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.· Conducts quality reviews for medical necessity and services provided. Facilitates peer review calls between facility and external organizations. Identifies potential review problems and discuss them with multi-disciplinary team and/or administration.· Acts as liaison between managed care organizations and the facility professional clinical staff.· Assists with any problems encountered during on-site or telephone reviews by the third-party payers or review organization, when necessary.· Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field required.· Two or more years of direct clinical experience in a psychiatric or mental health setting required.· Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.Why The Pavilion at Williamsburg Place?The Pavilion at Williamsburg Place offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. The Pavilion at Williamsburg Place is an EOE.Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
- J-18808-Ljbffr Summit BHC
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Utilization Specialist - Acute in Williamsburg, VA vacancy
- Summit BHC is seeking a Utilization Assistant for The Pavilion at Williamsburg Place in Virginia. This role involves supporting utilization review activities to ensure accurate reimbursement and coverage for patients while coordinating with insurance providers. The ideal...Suggested
- Summit BHC is hiring a Utilization Specialist at The Pavilion in Williamsburg, Virginia. This role involves performing and monitoring utilization reviews, ensuring compliance with clinical criteria, and coordinating with insurance providers for treatment approvals. Candidates...SuggestedFull time
- ...checklist and all other necessary reports. Collect, analyze, and interpret programmatic data to identify trends and areas for improvement; utilize data to create reports to support decision-making and data-driven efficiency; provide administrative support for organizational...SuggestedFull timeWork at officeLocal areaImmediate startFlexible hoursWeekend workAfternoon shift
GovernmentJobs.com
Williamsburg, VA4 days ago - ...Description We are currently seeking an Environmental Construction Specialist to work on Electric Utility Construction Projects.This is a field position, and candidates must have experience with environmental compliance in relation to land clearing and linear construction...SuggestedWeekly payFull timeTemporary workFor contractorsWork at officeRemote work
ArborMetrics Solutions, LLC
Williamsburg, VA4 days ago - Shelf-Life/Disposal Lead Specialist PA-08-7217 Williamsburg, VA RBCI provides generous benefits to our employees, including health, vision... ...and quality control for shelf‑life and disposal operations. Utilize approved inventory or logistics management systems to track...SuggestedContract workTemporary workWork at officeLocal area
$18 per hour
...Job Description Position Purpose: The Asset Protection Specialist is primarily responsible for preventing financial loss caused... ...program compliance in their assigned store/multiple stores. They utilize tools to minimize loss to the Company, including but not...Local areaHome Depot
Williamsburg, VA2 days ago- ...checklist and all other necessary reports. Collect, analyze, and interpret programmatic data to identify trends and areas for improvement; utilize data to create reports to support decision-making and data-driven efficiency; provide administrative support for organizational...Work at officeLocal areaImmediate startWeekend workAfternoon shift
York County, VA
Williamsburg, VA4 days ago - ...Hazmat Specialist Professional Solutions Delivered, LLC (ProSoDel) is a total solutions provider for government and commercial customers... ...messages, recalls, alerts, and affected product notices utilizing DMLSS or other military databases of record. Coordinate affected...Work at officeLocal area
Professional Solutions LLC
Williamsburg, VA4 days ago - ...Position Purpose: The Asset Protection Specialist is primarily responsible for preventing financial loss caused by theft and fraud and... ...program compliance in their assigned store/multiple stores. They utilize tools to minimize loss to the Company, including but not...
The Home Depot
Williamsburg, VA2 days ago $32.5 - $44.73 per hour
...Physician. Responsible for the assessment, planning, implementing, and evaluating the total nursing care of assigned patients. The RN utilizes communication, critical thinking, problem solving, and decision making to create a care plan for each patient based on...Work at officeRiverside Health System
Williamsburg, VA5 days ago- ...Disassemble & Reassemble Technician (DRT) to handle vehicle bumper repairs. The candidate will perform disassembly and reassembly tasks utilizing advanced equipment, ensuring all repairs meet industry and OEM standards. Previous experience is preferred but not required. The...
$63k - $66k
Shelf Life Disposal Specialist Full Time Williamsburg, VA, US 30+ days ago Requisition ID: 1546 Salary Range: $63,000.00 To $66,000.0... ...medical alert and recall messages related to shelf-life material utilizing DMLSS or other military databases of record. Coordinate with...Full timeWork at officeLocal area$61.82k
School Improvement Specialist (11 months) Williamsburg James City School District - James Blair Middle School, Williamsburg, Virginia... ...School Improvement Plan. Lead VDOE/Graduation Cohort cleanup and utilize SSWS Data Correction Tool. Assist with analyzing assessment...Full timeLocal areaWork visa$12.77 - $22 per hour
...proud to have an established Zoo Career Growth structure. Compensation Range - $12.77 - $22.00 an hour. Job Overview The Zoological Specialist, Associate is responsible for providing consistent care and training of the collection of all assigned animals at the Highland...Seasonal workFlexible hoursShift workNight shiftWeekend workDay shift- ...profit, integrated health network dedicated to serving the communities of Eastern Virginia. Riverside’s network of services includes acute care, Riverside Medical Group, lifelong health, academic residency programs and fellowships and community benefit initiatives....Full timeLocal area
$13.75 per hour
...world. If you're dedicated, dependable and driven to deliver exceptional guest service, this is a place for you!Seasonal Safety Specialist - Busch Gardens WilliamsburgWhat you get to do:This role is responsible for guest and Ambassador accident injury investigations;...Seasonal workWork at officeFlexible hoursShift workNight shiftAfternoon shiftEntertainment Places
Williamsburg, VA16 hours ago- ...Position Description & Qualifications Shelf-Life / Disposal Specialist Cheatham Annex Are you a logistics professional with experience supporting shelf-life monitoring and material disposition? Do you understand the importance of maintaining compliant and ready...Hourly payFull timeContract workPart timeFor contractorsFor subcontractorLocal areaImmediate startMonday to FridayFlexible hours
Serco
Williamsburg, VA2 days ago $18 - $20 per hour
...~ Employee discounts ~ Health insurance ~ Paid time off ~ Vision insurance Join Our Team as a Junk Removal Specialist at The Junkluggers! The Junkluggers of Williamsburg is a locally operated Franchisee, serving The Virginia Peninsulas including...Hourly payWork at officeLocal areaThe Junkluggers
Toano, VA3 days ago- ...SOLUTION ONE INDUSTRIES is seeking a Safety and Occupational Health Specialist for its client site in Williamsburg, VA. The successful candidate will play a pivotal role in ensuring compliance with health and safety laws, delivering training, and managing health programs...
Solution One Industries
Williamsburg, VA1 day ago - ...difference and want a role that combines purpose with an exceptional work-life balance, we invite you to join our team as a Fatherhood Specialist. Position Summary: Child Development Resources (CDR) inspires and empowers children, families, and early childhood...Work at officeLocal areaFlexible hoursAfternoon shift
Child Development Resources
Williamsburg, VA1 day ago - Colonial Williamsburg in Williamsburg, VA is looking for a Visitor Services Associate to enhance guest experiences in the Art Museums and Campbell Archaeology Center. Responsibilities include welcoming guests, addressing inquiries, and ensuring visitors have a positive...Casual workShift work
Colonial Williamsburg Company
Williamsburg, VA4 days ago - Colonial Williamsburg Foundation is looking for a Visitor Services Associate to engage with guests at the Art Museums. This role involves welcoming visitors, addressing inquiries, and ensuring a positive museum experience. Ideal candidates should have customer service ...Casual workShift work
Colonial Williamsburg Foundation
Williamsburg, VA2 days ago - ...multicultural, hard-working team. About The Role: Reporting to our Supply Chain Manager, we are seeking a highly motivated Commodity Specialist who will be responsible for managing supplier sourcing, approval, onboarding, delivery to PO schedule and ongoing performance...Immediate start
CEL - Critical Power
Williamsburg, VA5 days ago $12.77 - $18.4 per hour
...Parts Specialist Compensation Pay Range: $12.77 - $18.40 The actual hourly rate will equal or exceed the required minimum wage applicable to the job location. Additional compensation includes annual, quarterly performance, or premiums may be paid in amounts ranging per...Hourly payMinimum wageLocal areaFlexible hoursO'Reilly Auto Parts
Williamsburg, VA5 days ago$115k
...Overview Healthcare Specialist (US Army). Do you want to change your life, help others, and have fun while doing it? If so, serving as a full-time Health Care Specialist in the U.S. Army could be the right career choice for you. This is an entry-level position, now hiring...Permanent employmentFull timeWork at officeLocal areaImmediate startArmy Recruiting Office Suffolk
Williamsburg, VA2 days ago- ...Job Overview The Front Desk Specialist will serve as the front of the house liaison to facilitate an exceptional guest experience. Individuals will be the primary point of contact for guests checking into the resort, handling folio transactions, check‑out processes, and...Work at officeNight shift
Holiday Inn Club Vacations Incorporated
Williamsburg, VA5 days ago $140k - $220k
...Home Buying Specialist The Home Buying Specialist is responsible for buying homes for House Buyers of America. This person will follow up on leads, value houses, estimate repairs, and close deals, in addition to performing extensive due diligence on all acquisitions....Casual workWork at officeRemote workWeekend workAfternoon shiftHouse Buyers
Toano, VA2 days ago- ...Description: Leasing Specialist Full Time: 40 hours/week Hourly: Compensation is commensurate with experience FLSA Status: Hourly Schedule: Five days per week including alternating Saturdays as needed Reports to: Property Manager Job Description...Hourly payFull timeCurrently hiring
Levco Management
Williamsburg, VA2 days ago - Non-Invasive Cardiology Physician - Riverside Cardiology Specialists - Riverside Medical Group - Williamsburg, Virginia page is loaded## Non... ...of Eastern Virginia. Riverside’s network of services includes acute care, Riverside Medical Group, lifelong health, academic...Full timeLocal areaRelocation package
- Excel Fitness in Williamsburg, VA, seeks a part-time Member Service Representative to provide exceptional customer service at its club. Responsibilities include welcoming members, handling inquiries about memberships, and maintaining a clean and friendly environment. The...Part timeFlexible hours
Excel Fitness
Williamsburg, VA2 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Specialist - Acute. Be the first to apply!
Related searches
- mental health specialist Williamsburg, VA
- program specialist Williamsburg, VA
- art specialist Williamsburg, VA
- remote outreach specialist Williamsburg, VA
- information technology specialist Williamsburg, VA
- adoption specialist Williamsburg, VA
- licensing specialist Williamsburg, VA
- amazon specialist Williamsburg, VA
- event production specialist Williamsburg, VA
- facility management specialist Williamsburg, VA