Medical Claims Review Manager jobs in Pine Bluff, AR

Jefferson Regional Specialty Hospital is a new, state-of-the-art facility scheduled to open in Spring 2024 in White Hall, AR. Operated jointly between Jefferson Regional and Lifepoint Rehabilitation, a business unit of Lifepoint Health, this new 87,000-square foot, 76-bed hospital, housing 40 inpatient rehabilitation beds with an additional 36 behavioral health beds, will be located just north of Pine Bluff and south of Little Rock. If you are an enthusiastic individual seeking an environment dedicated to superior patient care and an organization with a strong mission to serve our community, we invite you to apply!

Job Responsibilities:

1. Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
2. Completes pre and re-certifications for inpatient and outpatient services.  Reports appropriate denial, and authorization information to designated resource.
3. Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations
4. Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
5. Works with CNO to ensure documentation requirements are met.
6. Ensure appeals are completed thoroughly and on a timely basis
7. Interface with managed care organizations, external reviews, and other payers
8. Communicate with physicians to schedule peer to peer reviews
9. Accurately report denials

Qualifications:

1. Bachelor’s degree or current clinical license preferred.
2. Previous utilization review experience in a psychiatric healthcare facility preferred
3. Current unencumbered clinical license and valid driver’s license preferred
4. CPR certification and Crisis Prevention Training (CPI) preferred

Jefferson Regional Specialty Hospital will provide inpatient rehabilitation services for adults who have experienced a loss of function or disability due to stroke, brain injury, spinal code injury, neurological disorders, orthopedic surgery and other conditions. Featuring all private rooms, the rehabilitation section of the hospital will provide intense, interdisciplinary rehabilitation therapies and medical care to improve patients’ functional independence and help them return home. In addition, Jefferson Regional Specialty Hospital’s distinct behavioral unit will offer a continuum of inpatient and outpatient behavioral health services for adults and seniors, including crisis stabilization for acute mental health and substance use disorders; detoxification from alcohol and drugs; and treatment for anxiety, depression, post-traumatic stress disorder and many other behavioral health illnesses.