Description

　　Bronson offers competitive pay and many other great benefits:

　　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

　　Generous PTO, Sick Time, Paid Holidays, and Professional Development Reimbursement

　　Utilization Review Specialist Job 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.

　　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.

　　Education/Experience/Skill Requirements:

　　Associate degree in nursing (LPN or RN) required. 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.