Sonora is the Leading Behavioral Health Hospital in Tucson, Arizona.
We are looking to expand our Utilization Review Team with a part-time Title 36 Specialist! The successful candidate will work well with several members of different departments. Administrative experience in healthcare required. Title 36 knowledge and experience preferred. At least two years' experience in behavioral health and utilization management preferred.

ESSENTIAL FUNCTIONS:

Act as liaison between courts, managed care organizations and the facility professional clinical staff. Organize and attend regular court hearings, as needed. File necessary paperwork to Pima County and other county courts for processing. 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.