Utilization Specialist

About the role

We are seeking a Full Time Utilization Specialist to join our team at TrustPoint Hospital. The ideal candidate will be passionate about behavioral health and dedicated to making a meaningful impact in their community.

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.
• Maintain accurate records and reports on patient length of stay and extensions.
• Develop and gather statistical and narrative information to report on utilization, non-certified days, 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.
• 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.
• Perform other functions and tasks as assigned.

Requirements

• High school diploma or equivalent.
• Two or more years' experience working with the facility's population.
• Previous experience in utilization management is 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).

Qualifications

• Education: High school diploma or equivalent. Preferred: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.

Skills

• Strong communication and interpersonal skills.
• Ability to manage multiple tasks and prioritize effectively.
• Knowledge of healthcare regulations and compliance.
• Proficiency in utilizing healthcare software and databases.

Benefits

• Medical, Dental, and Vision Insurance coverage.
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
• Company-paid Basic Life & AD&D insurance.
• Disability benefits.
• 401(k) Retirement Plan with a company match.
• Employee Assistance Program (EAP) and Employee Discount Program.
• Paid holidays for work-life balance.
• Paid time off (PTO).
• Tuition reimbursement opportunities for career advancement.

Pay

Compensation details are confidential and not specified in the job posting.

Schedule

Hours: Monday through Friday, 8am-5pm.