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Utilization Review Specialist- LPN or Social Worker

Company: Vermilion Behavioral Health
Location: Lafayette
Posted on: January 11, 2022

Job Description:

Vermilion Behavioral Health Systems provides a comprehensive benefits package which currently include:
Competitive salary
Medical, dental, and vision insurance
Acadia Healthcare 401(k) plan
Excellent training program
Professional growth opportunity that is second to none in the industry. Join a team with defined career paths and a national family of hospitals and facilities
UR typically works Monday-Friday normal business hours.
Essential Job Functions:
Act as liaison between managed care organizations and the facility's 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.
Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients.
Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients.
Facilitate peer review calls between facility and external organizations.
Act in coordination with the leadership team of the facility or corporate office to improve the quality of services provided within the organization.
Assist the admissions department with pre-certifications of care.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Vermilion Behavioral Health, Lafayette , Utilization Review Specialist- LPN or Social Worker, Healthcare , Lafayette, Louisiana

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