Utilization Specialist

Our facility has a capacity of 42 beds and serves individuals aged 18 and older, including 6 beds designated for detox. As a 12-step based, social model residential treatment center, Serenity Knolls combines traditional social models of care with contemporary cognitive behavioral, psychodynamic, and evidence-based practices. We invite qualified candidates to apply today. 

Diagnose and treat mental and emotional disorders, whether cognitive, affective or behavioral.

Compensation for roles at Serenity Knolls 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, Serenity Knolls provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

​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. 

• ​Perform other functions and tasks as assigned. 

• ​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 

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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.

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• ​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.