Description

　　PURPOSE STATEMENT:

　　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.

　　Perform other functions and tasks as assigned.

　　EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

　　Associate's degree in nursing (LPN or RN) allowed. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.

　　Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

　　LICENSES/DESIGNATIONS/CERTIFICATIONS:

　　Current licensure as an LPN or RN 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.

　　BENEFITS:

　　Competitive benefits package offered including:

　　Medical insurance

　　Dental insurance

　　Disability insurance

　　Life insurance

　　Acadia Healthcare 401(k) plan

　　COMPANY MISSION:

　　Our Mission is to improve the quality of life of our patients and their family members.

　　TrustPoint is a state of the art hospital offering two specialty service lines; Acute Physical Medicine and Rehabilitation Services and Behavioral Health Services for Adults and Seniors.

　　At TrustPoint Rehabilitation Hospital, our aim is simple: to help people recovering from illness or injury attain the highest possible quality of life. Our goal is to help you meet and exceed your recovery goals while providing a shorter length of stay than skilled nursing facilities.

　　Behavioral Health at TrustPoint Hospital, we believe each patient is unique. That's why we focus on treating the whole person not just the illness. Offering acute inpatient behavioral health services for adults and seniors. TrustPoint also offers intensive outpatient behavioral health services for adults.

　　Qualifications

　　Education

　　Preferred

　　Bachelors or better in Nursing/Healthcare

　　Masters or better in Nursing/Healthcare

　　Licenses & Certifications

　　Required

　　Reg Nurse

　　Lic Practical Nurse

　　Experience

　　Preferred

　　2 years: Experience with population of facility and experience in utilization managementEqual 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)