Description

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.

• Hours: Tuesday- Saturday 8:00 am - 5:00 pm

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• LPN Diploma with a current NC Nursing license OR Associate’s Degree in Nursing (RN) with current NC Nursing license OR Bachelor’s Degree in Social Work, Behavioral Health, Mental Health or other related healthcare field required

• CPR and CPI certification (training offered onsite)

• Teamwork and excellent customer service

PREFERRED:

• Master's Degree in Social work, behavioral Health, Mental Health or other healthcare related field preferred

• Current NC clinical professional licensure/certification preferred

• Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

BENEFIT/COMPENSATION (after 30 days of employment):

• BC/BS Health Insurance (3 plans to choose from, eligible after 30 days of employment)

• Delta Dental (2 plans to choose from)

• NVA Vision Insurance

• Paid life and AD&D insurance

• 401k with a matching contribution

• Vacation/Sick/Extended Sick

• Personal/Holiday time

• Short term and Long term disability

• Free onsite employee fitness center

• Free meals

• Employee Discount program

• Employee Fun events

• Annual Performance Review and Merit Increase Review

• Salary increases for obtaining education degrees, professional certification and/or licensure (based on program of study/ field of certification and licensure)

• License/Certification renewal and reimbursement

Ranked by Newsweek in 2020 and 2021 as one of North Carolina’s Best Addiction Treatment Centers, Wilmington Treatment Center is North Carolina’s premier substance abuse recovery hospital and rehabilitation center located in the beachside community of Wilmington, NC. What began as a 22 bed hospital on one campus in 1984 has grown into a 260 bed hospital spanning 3 campuses! We are a team of professionals dedicated to helping our patients begin their recovery from the disease of addiction. Even though we are growing, we still maintain that feeling of a close knit community. We offer a fantastic comprehensive benefit package, a great team of co-workers as well as the opportunity to make a difference in the lives of those we serve.

Qualifications

Skills

Required

• Problem Solving: Advanced

• Communication: Expert

• Attention to Detail: Expert

Behaviors

Required

• Team Player: Works well as a member of a group

• Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

Required

• Self-Starter: Inspired to perform without outside help

• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Education

Required

• Bachelors or better in Social Work

• Associates or better in Nursing/Healthcare

Preferred

• Technical/other training or better in Social Work

Licenses & Certifications

Required

• Reg Nurse

• Lic Practical Nurse

Experience

Preferred

• 2 years: Utilization Management

• 2 years: Substance Abuse

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)