Utilization Specialist

Utilization Specialist

Join a compassionate team where your creativity and therapeutic skills truly make a meaningful impact on the lives of our patients.

Bronson Behavioral Health Hospital is hiring a full-time Utilization Specialist. The Utilization Specialist will act as a liaison between managed care organizations and the professional clinical staff at the hospital.

The hourly pay range for this position is $35.00 -$42.00. Bronson offers competitive wages along with a comprehensive benefits package and many additional perks.

• Three Medical Plan Levels, Dental and Vision Insurance
• HSA with a Company Contribution
• FSA Dependent Care Flexible Spending Account
• Basic Life/AD&D and Supplemental Life Insurance
• Short-Term and Long-Term Disability Insurance
• 401k with a Company Match
• EAP (Employee Assistance Program)
• Employee Discount Program
• Vacation, Sick Time, Personal Days, and 8 Paid Holidays
• Tuition Reimbursement
• Access to continuing education credits at no cost to you
• Paid training and professional development

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

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 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.

Other Functions:

• Perform other functions and tasks as assigned.

Education/Experience/Skill Requirements:

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.

Licenses/Designations/Certifications:

• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
• First aid may be required based on state or facility requirements.