Essential Job Functions:

• Act as a liaison between managed care organizations and facility's professional clinical staff.
• Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations and coordinate the flow of communication concerning reimbursement requirements.
• Inform clinical and medical staff of any specific concerns that would extend or restrict the length of stay of patients.
• Keep accurate record of all contact with external organizations and persons who have legitimate interest and legal access to information on the care of patients.
• Facilitate peer review calls between facility and external organizations.
• Act in coordination with the leadership team of the facility or corporate office to improve the quality of services provided within the organization.
• Assist the Admissions Department with pre-certifications of care.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Gather and develop statistical and narrative information to report to utilization, non-certified days(including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.

Why Work For Lakeview?

• Medical, Dental and Vision Insurance
• HSA and FSA Health Safety Options
• Company Sponsored Life Insurance Plan w/Additional Term Life Options Available
• Company Sponsored Credentialing Including: TB, CPI and CPR
• Employee Discount Program
• Employee Assistance Program
• Paid Days Off / Sick Leave / Extended Sick Leave
• And much more!

Experience

• 2 year(s): Utilization Review in Healthcare Setting

Education

• Bachelors or better in Social Work or related field
• Bachelors or better in Psychology or related field
• Bachelors or better in Business or related field

Skills

• Financial Awareness
• Attention to Detail
• Computer - Excel

Equal 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)