UR Specialist/Discharge Planner - PRN

• Dedicated military personnel
• Adults
• Seniors
• Children and adolescents (ages 5 through 17)

• 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.

• Develop continuing after care plan, based on patient's needs, to promote long term health and relapse prevention.
• Responsible for setting discharge appointments for patients, including group or individual therapy, psychologist or psychiatrist.
• Make arrangements for community resources to facilitate discharge. Provide all needed documentation to other providers to facilitate the continuum of care.
• Act as a liaison between referral sources, patients and counselors.
• Ensure all patient discharge planning documentation is clear, concise and timely.

• Perform other functions and tasks as assigned.

• Associate's degree in nursing (LPN or RN) required; Bachelor's Degree Preferred. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
• One or more years’ experience in a clinical setting preferred.
• One or more years’ experience in discharge planning preferred.
• Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

• 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 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.

Acadia Healthcare