About us
Duffy’s Napa Valley Rehab is seeking a Utilization Specialist to join our team! Since 1967, Duffy’s has been providing detox and addiction treatment for adults in northern California. This 21-acre resort is specifically tailored to promote well-being and genuine healing. Our program is made possible by the excellent clinical care from our staff of qualified and accredited professionals.
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:
· Associate's degree in nursing (LPN or RN) required. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
· Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
· Current licensure as an LPN or RN 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 required (training available upon hire and offered by facility.
· First aid may be required based on state or facility requirements.
Compensation for roles at Duffy's Napa Valley Rehab 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, Duffy's Napa Valley Rehab 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: $24.00-$27.00 per hour
Job Type: Full-time (40 hours per week)
Job Type: Full-time
Pay: $24.00 - $27.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work Location: In person