​Join Ascension Saint Thomas Behavioral Health Hospital in Nashville, Tennessee, a leading provider of behavioral health services. We are actively seeking a compassionate Utilization Specialist to enhance our team of dedicated professionals. Renowned for offering a comprehensive continuum of care for adults and seniors, Ascension Saint Thomas strives to deliver empathetic, individualized treatment solutions. If you are passionate about contributing to a top-tier behavioral health facility and making a difference in the lives of those experiencing mental health challenges, we welcome you to apply.

*Schedule: 8:30am-5pm Monday-Friday*

*4 days in-office, 1 work from home day (Tuesday or Thursday only)*

Ascension St. Thomas Behavioral Health provides a comprehensive benefits package for our team members. Current benefits include:

• Health Coverage: Comprehensive medical, dental, and vision insurance plans.
• Paid Time Off: Generous PTO policies to support work-life balance.
• Employee Perks: Enjoy discounts across a wide range of products and services through our Employee Discount Program.
• Support in Times of Need: Access to our Employee Disaster Assistance Program for unforeseen circumstances.
• Retirement Planning: Participate in the Acadia Healthcare 401(k) plan with robust investment options.
• Professional Development: Benefit from an excellent training program to enhance your skills.
• Career Advancement: Experience professional growth opportunities unparalleled in the industry, within a national network of hospitals and facilities.

PURPOSE STATEMENT: 

​Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

​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. 

​OTHER FUNCTIONS:  

• ​Perform other functions and tasks as assigned. 

​EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

• ​Required Education: High school diploma or equivalent. 

• ​Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 

• ​Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

​LICENSES/DESIGNATIONS/CERTIFICATIONS:  

• ​Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within 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.   

• ​First aid may be required based on state or facility requirements. 

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​ADDITIONAL REGULATORY REQUIREMENTS: 

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​While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

AHPILOT

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