Top 6 Utilization specialist Jobs in Ocala Fl

Utilization Specialist
The Refuge, A Healing Place —Ocklawaha, FL
- $20 - $24 an hour
- Full-time
- CPR Certification
- Nursing
- BLS Certification
7d
PATIENT ACCESS SPECIALIST
HEART OF THE VILLAGES PLC —Lady Lake, FL
- Full-time
- Bilingual
- HIPAA
- Mid-level
Quick Apply
9d
Lead Engagement Specialist
Colen Built Development —Ocala, FL
- Full-time
- Spanish
- Clean driving record
- Microsoft Excel
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply

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Patient Care Specialist
Millennium Physician Group, LLC —Ocala, FL
Answers and routes phone calls, schedules or reschedules appointments, and maintains daily appointment schedules while communicating adjustments to clinical…
$16.20 - $24.30 an hour
Quick Apply
3d
Medical Office Specialist
Ocala Health Trauma —Ocala, FL
You will manage all front office functions including patient relations, check-in/check-out, scheduling, insurance verification, and answering phones.
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13h

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…
9d
Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
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4d

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Utilization Specialist

The Refuge, A Healing Place -
Ocklawaha, FL

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Job Details

Full-time
$20 - $24 an hour
7 days ago

Qualifications

CPR Certification
BLS Certification
High school diploma or GED

Full Job Description

Overview:

Are you prepared for the impact you can make in your UR career at a well-respected treatment center in Ocklawaha, Florida? If so, you may enjoy working at The Refuge, a Healing Place, an trauma treatment facility set on 96-acre campus located in the Ocala National Forest. The Refuge provides premier residential treatment for adults aged 18 and older who are struggling with substance use disorders, behavioral health, trauma, eating disorder and other co-occurring disorders.

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week.

PURPOSE STATEMENT:

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

Pay for this position ranges from $20 - $24/hr based on relevant work experience.

Responsibilities:

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.

Qualifications:

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:

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.

ADDITIONAL REGULATORY REQUIREMENTS:

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.

REFHP

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utilization specialist jobs in ocala fl

Utilization Specialist

PATIENT ACCESS SPECIALIST

Lead Engagement Specialist

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

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