Utilization Specialist Job at Acadia Healthcare (Scotts Valley)

Utilization Review Specialist - PRN

San Jose Behavioral Health is currently seeking a Utilization Review Specialist ...

Location

United States , San Jose

Salary:

33.00 - 60.00 USD / Hour

Acadia Healthcare

Expiration Date

Until further notice

Requirements

Associate Degree in Nursing(LPN/LVN/RN) Required
Two or more year's experience with the population of the facility preferred
Previous experience in utilization management is preferred
LMFT, LMSW, LCSW, LPC, LPC-Iwithin 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)
Bachelors or Masters degree in Social Work, Behavioral Health Or Mental Health, Nursing or Other related health field preferred

Job Responsibility

Coordinate and assess the inpatient census for appropriate alternate health care service needs
Perform on-site and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines
Coordinate with appropriate discharge planning processes, providing feedback on documentation processes
Function as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options
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

Utilization Insurance Specialist

To provide clinical information to Managed Care/Insurance Companies/BHO to demon...

Location

United States , New York

Salary:

65885.00 - 98827.00 USD / Year

Mount Sinai Health System

Expiration Date

Until further notice

Requirements

Master’s Degree Preferred with experience in related field
Experienced in Insurance care management or utilization management

Job Responsibility

Responsible for all aspects of the concurrent review program, insurance certification, and authorization process for all Psychiatric or Chemical Dependency Inpatient Units
Develops rapport with and daily working relations Admitting and Inpatient clinicians to insure ongoing, comprehensive clinical information
Maintains daily communications and documentation with all Hospital Insurance Verification and Patient Accounts staff to insure timely verification of patient insurance and insurance status
Coordinates insurance authorizations through provision of appropriate clinical information
Communicates with inpatient clinical staff to insure timely discharge planning is in place when insurance authorizations expire
Monitors and coordinates the designation of alternative level of care with the UM Manager and/or Program Manager and Physician
Notifies and coordinates inpatient services when delays are noted in order to reduce length of stay and improve quality of care
Responsible for data and report generation of providers as well as regulatory agencies
Demonstrates the knowledge and skills necessary to provide care based on physical, psychosocial, educational, safety, and related criteria
Utilizes Hospital Mainframe programs, CANOPY Care Management System, and TRAC effectively

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status
Generates approval, modification and denial communications, to include member and provider notification of referral determination
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps
Follows up with caller to provide response or resolution steps

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Excellent time management and priority-setting skills
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Water Safety Specialist I

Perform opening, operating and closing duties according to the guidelines set by...

Location

Bahamas , Paradise Island Nassau

Salary:

Not provided

Four Seasons

Expiration Date

Until further notice

Requirements

Applicants that are interested in applying, please note that the position is based on The Ocean Club, A Four Seasons Resort Property located in The Bahamas and is available to those individuals who possess a legal ability to work in The Bahamas without sponsorship.

Job Responsibility

Perform opening, operating and closing duties according to the guidelines set by the security department
Monitor guest activity within area of responsibility to ensure a continual safe environment
Respond to all emergencies within assigned zones, with specific focus on Waterfront (Beach) areas
Utilize trained techniques including operation of watercraft and rescue boards to enter water and assist or rescue individuals that require aid
Administer First Aid and/or CPR during emergency situations
Recognize hazardous situations and behaviors and promptly respond accordingly
Assist in removal and retention of guests during pool or beach evacuation procedures
Completely abide by and enforce all Pool and Beach rules and regulations
Conduct and lead morning physical conditioning and exercises
Perform equipment checks to ensure equipment is in proper condition and good working order

Fulltime

New

Water Safety Specialist

About Four Seasons: Four Seasons is powered by our people. We are a collective o...

Location

Bahamas , Paradise Island Nassau

Salary:

Not provided

Four Seasons

Expiration Date

Until further notice

Requirements

Ability to work in The Bahamas without sponsorship

Job Responsibility

Monitor guest activity within area of responsibility to ensure a continual safe environment
Respond to all emergencies within assigned zones, with specific focus on Waterfront (Beach) areas
Utilize trained techniques including operation of watercraft and rescue boards to enter water and assist or rescue individuals that require aid
Administer First Aid and/or CPR during emergency situations
Recognize hazardous situations and behaviors and promptly respond accordingly
Assist in removal and retention of guests during pool or beach evacuation procedures
Manually control the motorized ride lift operation by utilizing a mechanical ride control switchboard to start, stop and evacuate motorized ride lifts
Manually control motorized ride dispatch station operation by utilizing a mechanical ride dispatch switchboard to safely launch riders onto the slides
Closely supervise all ride activity on live video monitors located in the video control room
Completely abide by and enforce all Water Park and beach rules and regulations

Fulltime

New

Account Specialist-Global Sales (Coordinator)

The Account Specialist GSO executes the merchandising of group, contract, busine...

Location

Mexico , Mexico City

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

High School diploma or equivalent required
Minimum of 2 years’ experience in Sales and Marketing, Guest Services, Front Desk or related professional area OR a 2-year degree from an accredited university in Business Administration, Marketing, Hotel and Restaurant Management required
Ability to develop reports, business correspondence, read, understand policy and procedures manuals
Ability to communicate effectively with all levels of internal and external customers
Attention to detail and accuracy
Knowledge on RFP and data base administration
Ability to work well as a team
Ability to work under pressure and meet deadlines in a timely manner
Time management and organizational skills, under heavy workloads with frequent interruptions, with the ability to react positively to job pressure and changing priorities
Strong proficiency in both English and Portuguese

Job Responsibility

Evaluate, qualify and respond to leads in a professional and timely manner
Act as the liaison between the customer and hotel(s) to present rate proposals, maximize or convert potential bookings, and close the sale
Generate the follow up and submission of contracts to finalize sales transactions (both group and transient business)
Ensure business is transitioned to designated property appropriately and in a timely manner for proper service
Provide service to customers to grow account share on behalf of MI, across the enterprise (Marriott Enterprise and Milux)
Participate on project and account teams, executing activities that support strategic account management and team-based sales models
Support managers and-or directors on sales calls, as appropriate
For assigned accounts, provide proactive account management support with primary focus on both the transient and group segments
Provide support for sales program/event coordination
Act as liaison communication with Travel Counselors of the TMC´S and sales activities support

Fulltime

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Utilization Specialist

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