<p>PURPOSE STATEMENT:</p> <p>Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.</p> <p>ESSENTIAL FUNCTIONS:</p> <ul> <li>Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers. </li><li>Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay. </li><li>Evaluate the utilization program for compliance with regulations, policies and procedures. </li><li>Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment. </li><li>Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation. </li></ul> <p>OTHER FUNCTIONS:</p> <ul> <li>Perform other functions and tasks as assigned. </li></ul> <p>LICENSES/DESIGNATIONS/CERTIFICATIONS:</p> <ul> <li>If applicable, 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. </li><li>CPR and de-escalation and restraint certification required (training available upon hire and offered by facility). </li><li>First aid may be required based on state or facility requirements. </li></ul> <p>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.</p> <p>GBHNE</p>