Utilization Assistant- Acute

Utilization Assistant- Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: The Pavilion is looking for a Utilization Assistant to join our team! -Pay Range: $20–$24/hour -Full-time Day Shift -Complimentary Continued Education -$3000 per year Tuition Assistance -Benefits- Medical, Dental & Vision after 30 days -Flex Pay-Daily pay option -PTO package -Much more!

About Summit BHC

• Veterans and military spouses are highly encouraged to apply.
• Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country.
• We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

Responsibilities

• The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information.
• Works with insurance providers to obtain coverage for patients.
• Assists in utilization reviews and insurance appeals.
• Responds to inquiries from patients, their families, and professional referral sources.
• Assists the admissions department with pre-certifications of care.
• Performs pre and post admission benefit verification with managed care organizations. · Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record. · Conducts interactive and timely reviews with payers to ensure certification of care. · Maintains accurate documentation and files as it relates to utilization management. · Coordinates information and findings with the business office to help recognize or resolve possible payment problems. · Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs. · Ensure that insurance benefits are verified in a timely manner. · Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems. · Responds to telephone and Internet inquires. · Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.

Requirements

• High School Diploma Required, Bachelor’s Degree in social work, behavioral or mental health, or other related health field preferred. · One or more years of direct clinical experience in a psychiatric or mental health setting preferred.

Benefits

• Why The Pavilion at Williamsburg Place?The Pavilion at Williamsburg Place offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.

Education/Requirements

Qualified candidates should apply by submitting a resume. The Pavilion at Williamsburg Place is an EOE.