Full Time Utilization Review Social Worker Jobs (NOW HIRING)

Utilization Specialist  Opportunity (8hours shifts) at The Camp Recovery Center – Scotts Valley, CA

Pay Range$25.00 - $27.00:

We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley! This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.

Medi-Cal Experience and Understanding Preferred

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 
• UM Experience preferred
• Medi-Cal experience and understanding 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. 

COMPENSATION:

Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

Role Location: CALIFORNIA

Calculated Hourly Range for role Utilization Specialist

State – California: $25.00 - $27.00

BENEFITS: For Full Time Staff only

The Camp Recovery Center provides a comprehensive package of benefits for our Full Time Utilization Specialist..                       Current benefits include:

• Competitive hourly rate
• Shift differential for overnight shifts
• Medical, dental, and vision insurance
• Acadia Healthcare 401(k) plan
• Excellent training program
• Complimentary AOD Education to certify as a Substance Use Disorder Counselor
• Professional growth opportunity that is second to none in the industry.

AVAILABLE SHIFTS AND HOURS:

This is a Full-Time EMT position Monday - Friday . Shifts are 8 – hours, and are overtime eligible

ADDITIONAL REGULATORY REQUIREMENTS: 

As Needed