Utilization Review Specialist

BOWLING GREEN BRANDYWINE:

Bowling Green Brandywine is a leading Drug & Alcohol Addiction Treatment center and is located in the scenic and historic countryside of Pennsylvania’s Brandywine River Valley. It has been a premier provider of effective chemical dependency treatment for more than 30 years. Throughout these years, Bowling Green Brandywine has been committed to provide life-changing treatment for men and women who are struggling with addiction. Today, we are proud to offer a full spectrum of residential addiction treatment services including a special program focused entirely on the problem of prescription drug abuse and opiate addiction.

ACADIA HEALTHCARE:

Bowling Green Brandywine is a proud client of Acadia Healthcare which is a for-profit health system, providing mental health and substance-use disorder treatments with locations throughout the United States and Puerto Rico. As a leading provider of behavioral healthcare services, Acadia Healthcare operates under the large network of 227 behavioral healthcare facilities with approximately 9,900 beds in 40 states and have around 20,000 employees serving approximately 70,000 patients daily.

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:

1) County funding paperwork

• Meeting clients to complete county paperwork and filing for MA
• Corresponding with the county SCA 

2) Financial counseling

• Meeting with clients to collect any co-payments
• Create payment plans for those who can’t pay all of it upfront
• 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.

WHAT DO WE OFFER:

• Health Insurance
• Dental Insurance
• Vision Insurance
• EAP Services
• Education Assistance Program
• 401 K
• Competitive PTO benefits