Utilization Specialist - Acute
Summit BHC(1 month ago)
About this role
The Utilization Specialist at Carolina Dunes Behavioral Health reviews admissions, continued stays, and discharge planning using clinically valid criteria to obtain authorizations and ensure appropriate utilization. The role coordinates utilization management activities, communicates with payers and clinical staff, and provides education and reporting to support reimbursement and quality initiatives. It focuses on ensuring medical necessity, managing appeals, and improving processes related to patient length of stay and payment coordination.
Required Skills
- Utilization Review
- Admission Review
- Concurrent Review
- Appeals Management
- Precertification
- Benefit Verification
- Discharge Planning
- Documentation
- Staff Training
- Payer Communication
+2 more
Qualifications
- Graduation from Accredited School of Nursing
- Bachelor's Degree in Social Work
- Bachelor's Degree in Behavioral or Mental Health
- Bachelor's Degree in Related Health Field
About Summit BHC
summitbhc.comSummit Behavioral Healthcare, Addiction Treatment Centers in AZ, CA, CO, GA, IA, IN, KS, LA, MO, NJ, NM, NC, PA, SC, TN, TX, VA, WV, & WI.
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