Description :Are you prepared for the impact you can make in your UR career at a well-respected treatment center in Brooksville, Florida? If so, you may enjoy working at Sabal Palms Recovery Center, an addiction treatment facility nestled on a 10-acre campus located along Florida's Nature Coast and surrounded by live oak trees. Sabal Palms Recovery Center provides premier residential treatment for adults aged 18 and older who are struggling with addictions.Our skilled professionals are focused on sharing their knowledge and expertise to help you get acclimated to your new role. Along with detailed training and continual support, our staff will give you the autonomy you need to achieve your career goals. You will love working to make a difference in the lives of our patients as you collaborate with other professionals and a supportive management team.We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week.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.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

High School diploma or equivalent required.
Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).
First aid may be required based on state or facility.

BENEFITS:

Medical, Dental, and Vision Insurance
HSA & FSA
Company Paid Basic Life & AD&D
Disability
401(k) Retirement Plan - with company match
Employee Assistance Program/Employee Discount Program
Paid Holidays
Paid Time Off
Tuition Reimbursement

Skills : Written Communication: Novice
Problem Solving: Novice
Financial Awareness: Expert
Communication: Advanced
Attention to Detail: AdvancedBehaviors : Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Functional Expert: Considered a thought leader on a subjectMotivation : Self-Starter: Inspired to perform without outside help
Financial: Inspired to perform well by monetary reimbursementEducation : High School/GED

UR Specialist

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