Utilization Review Specialist/Officer Manager

ABOUT US

The Hope Center, Inc. is a well-respected and leading recovery organization in Lexington, Kentucky-the second largest city- that cares for the homeless and at-risk persons by providing life-sustaining and life-rebuilding services that are comprehensive and address underlying addiction causes.

PURPOSE

The Utilization Review Specialist plays a crucial role in ensuring the efficient and effective utilization of resources within our substance abuse treatment center. This position involves conducting comprehensive reviews of client treatment plans, assessing the appropriateness and necessity of services rendered, and collaborating with internal teams and external stakeholders to optimize the delivery of care. This position will also work closely with the Residential Program/IOP Director and treatment team in the care and oversight of clients and the successful operation of the treatment program. Duties require close coordination, collaboration, tracking, and monitoring of residents to ensure compliance with all regulations and supporting staff in direct care and management of clients.

RESPONSIBILITIES
Responsibilities include, but are not limited to:

· Conduct thorough reviews of client treatment plans to evaluate the appropriateness and necessity of services provided.

· Meet with clients upon first admission to the program, set up intakes and enter information into electronic health records.

· Orient new clients by educating them on available services, requirements, and program policies.

· Answer phones, direct calls to appropriate individuals and prepare messages.

· Maintain accurate and detailed records of utilization review activities, ensuring compliance with regulatory requirements and organizational policies.

· Work closely with clinical staff, case managers, and external partners to facilitate communication and coordination of care.

· Verify clients' insurance coverage and benefits to determine eligibility for services and facilitate reimbursement.

· Assist in the appeals process for denied claims, providing necessary documentation and support to overturn adverse decisions.

· Participate in ongoing quality improvement initiatives, identifying opportunities for enhancing service delivery and efficiency.

· Provide education and training to staff on utilization review processes, documentation requirements, and best practices.

· Ensure compliance with relevant regulatory standards, including HIPAA, state licensing regulations, and accreditation requirements.

· Participate in day-to-day activities, providing crisis intervention, educating clients in recovery and life skills, and advocating for clients.

COMPETENCIES
Required competencies include:

· Strong understanding of insurance verification and billing processes.

· Excellent organizational skills and attention to detail, with the ability to manage multiple tasks simultaneously and meet deadlines.

· Effective communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams and external stakeholders.

· Knowledge of relevant laws, regulations, and accreditation standards governing utilization review and healthcare delivery.

· Commitment to ethical practice.

REQUIRED EDUCATION/EXPERIENCE

• Some college experience required; bachelor’s degree preferred.
• At least 2 years' experience working in an inpatient residential program.
• Peer Support Certification preferred.
• Current state-issued photo identification.

HOURS
This is a full-time position, regularly scheduled Monday – Friday; 8:00 a.m. – 4:00 p.m. This position requires flexibility in scheduling as well as the ability to cover shifts as needed.

BENEFITS

This is a full-time position offering the following benefits:

• Health insurance, Dental insurance, Vision insurance
• 401(k) with matching percentage from the Hope Center
• Life insurance
• Flexible Spending Account (FSA)
• Paid Vacation & Sick Leave

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Healthcare setting:

• Inpatient

Schedule:

• 8 hour shift
• Monday to Friday
• Weekends as needed

Education:

• High school or equivalent (Preferred)

Experience:

• inpatient residential: 2 years (Required)

License/Certification:

• peer support certification (Preferred)

Work Location: In person