Utilization Review Specialist

Has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. The position supports the CSU UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Will monitor adherence to the facilities utilization review plan to ensure the appropriateness of admissions and extended stays. Position requires oversight for all prior and concurrent authorizations and any related appeals for insured patients admitted into Henderson’s crisis stabilization unit. Is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. Monitors the effectiveness/outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed. Identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. Education:   Master’s Degree in Social Work, Mental Health Counseling or Marriage and Family Therapy.

Section: Acute Care Services

Location: Broward County

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