Oasis Behavioral Health
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Utilization Management - Title 36 Specialist Part-time
at Oasis Behavioral Health
The UM Title 36 Specialist serves as the primary point of contact for the involuntary commitment process per Arizona Revised Statutes, Title 36. The UM Title 36 Specialist will work closely with County Attorney Office’s around the State of Arizona, the different RHBA’s of Arizona, and the Arizona Superior Court on a daily basis. Will compile & maintain data for monthly reports that will need to be submitted, complete legal documents on a daily basis, and attend court hearings. Will coordinate getting the patient to the proceedings that take place in the Hospital Court Room. The UM Title 36 Specialist is also responsible for the daily submission of mental health legal documents to the County Attorney's Office, and the Superior Court.
The UM Specialist also collects, analyzes and provides pertinent, timely clinical information to payer sources and external utilization review personnel for authorization of inpatient stay and/or outpatient services. Serves as a member of the inpatient-multi-disciplinary treatment team providing information related to medical necessity, review criteria, and patient beliefs.
- 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.
- 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.
- Ability to complete Handle with Care course.
- Clear TB screening.
- Level One Fingerprint Clearance Card
- Clear background and drug screen.