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Utilization Review Analyst - Full Time

NUWAY

Saint Paul, MN | Full Time

$75k-99k (estimate)

9 Months Ago

Full time - SAP SD module Analyst - Onsite - MN

Tanson Corp

Saint Paul, MN | Full Time

$70k-86k (estimate)

3 Days Ago

Utilization Review Analyst - Full Time

NUWAY Saint Paul, MN

$75k-99k (estimate)

Full Time | Specialty Trade in Construction 9 Months Ago

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NUWAY is Hiring a Remote Utilization Review Analyst - Full Time

Position Overview

The Utilization Review Analyst will support the Utilization Review department which acts as a liaison between the clinical treatment team and third-party payers to promote appropriate treatment services, documentation practices and billing integrity for SUD treatment. The Utilization Review Department position ensures system integrity through the treatment continuum from clinical to claims management. Utilization Review Analysts work in a team environment and collaborate with each other to support the department’s responsibilities within NUWAY Alliance as well as other members of the team. This position will also work in conjunction with other departments within the organization to support improvement in the overall quality, completeness and accuracy of medical record documentation.

This position allows for a hybrid workplace, utilizing a telecommute work environment. The Utilization Review Analyst must be able to maintain client confidentiality in accordance with state and federal guidelines and HIPAA requirements.

Responsibilities

Audit documentation across NUWAY Alliance programs to substantiate appropriate clinical documentation practices, inclusive of providing data and feedback to staff and leadership about patterns, trends and gap analysis
Collaboration with Admissions and Clinical teams to identify clients entering treatment programming to determine funding
Secure funding for client’s admitting into NUWAY Alliance programs and documents approved funding source with approval units and/or dates
Complete documentation to support extension of funding for programming services, while reviewing medical necessity criteria
Develop and maintain efficient processes related to client funding, including prior authorizations and concurrent reviews for third party payors
Facilitate communication with Clinical teams to obtain appropriate clinical documentation to ensure that clinical documentation reflects the level of service rendered to clients is complete, accurate and medically necessary
Communicate data related to insurance payers, denials and extension requests in a clear and timely manner
Maintain current information about third party criteria for reimbursement and establish and maintain relations with payers to promote positive and direct communication
Support all Medical Records Requests from third party payers
Serve cross-functionally with Clinical teams, Leadership and Billing/Revenue Cycle teams, as well as other internal teams to assist in identification of overpayments
Support the execution of internal controls to prevent issues with billing, documentation and other processes as applicable
Maintain positive and open communications NUWAY Alliance staff, departments and leadership
Conduct oneself in a manner that presents a positive reflection of professionalism, as an asset to the image of the organization
Other duties as assigned or required

Competencies

Support the Clinical teams with regulation and standard implementation and understanding of the utilization review process
Utilize clinical knowledge and licensure to support utilization review activities of the organization
Understand and apply the importance of self-awareness in one’s personal, professional, and cultural life
Provide services appropriate to the personal and cultural identity and language of the client and other professionals
Understand the treatment modalities and clinical application to practice at NUWAY to support effective training resources

Qualifications, Skills, Knowledge and Experience

Required:

Bachelor’s degree with a major or concentration in a related field
Current LADC license required
Age 18 or older
Clinical documentation integrity, clinical quality improvement, utilization review, discharge planning, or case management experience of at least one year
At least 1 year of providing Substance Use services in an individual and group counseling setting
Knowledge of ICD-10 and DSM-5
Able to pass Minnesota DHS background study
Must be free of problematic substance use for at least two years immediately preceding employment and must sign a statement attesting to that fact
High degree of computer literacy including experience using an electronic health records (EHR) system
Excellent written, communication, customer service, and case management skills
Ability to relate to people from diverse backgrounds
Demonstrated working knowledge in the field of substance use disorder and/or mental health, in an addiction treatment facility
Physical Demands: Sitting for extended periods of time. Daily use of general office and/or residential facility equipment. Lifting (max 25 pounds), minimal reaching, bending and stooping. Ability to effectively navigate program or office environment such as ascending and descending steps, passing through doorways and entrances, and accessing program/office facilities.

Preferred: