Utilization Review Manager

Position Overview: Coordinates utilization functions and personnel to comply with hospital procedures and federal regulations. Acts as an internal resource for questions regarding patient care. Ensures that Ascend facility staff is caring for patients appropriately. May require a bachelor's degree or equivalent experience in field or related area. Familiar with standard concepts, practices, and procedure. This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers. This position will assess clients to determine the appropriate Level of Care and will obtain authorization for a caseload of patients. The Utilization Review Specialist is responsible for organizing and coordinating Utilization Review activities within the facility in accordance with standards of State and Federal regulations, accreditation standards, and payor guidelines. Performs a variety of tasks. Reports to Director of Residential Services.

· Specific Responsibilities:

· Completes Initial, concurrent, Peer Reviews, Expedited Appeal Reviews, and retrospective reviews in a timely manner to ensure continuous coverage.

· Maintains billing information based on census boards and communicates to relevant parties at the facility and the Billing Manager any issues with coverage or denials, billing issues and facilitates client notifications as needed. Maintains all company census for discharges and admissions, payor source and supplies Billing Manager on the 1st and 15th of each month.

· Attends and participates in Treatment Team Meetings as the payor expert to ensure appropriate authorization outcomes and provide ongoing education regarding payor requirement

· Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.

· Collaborate with Clinicians daily in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.

· Provide Customer Service to accounts

· Prepare and submit Appeals
Works with Director of Residential Services.
Provides information at the request of DRS
Consistently works to assist with the development of new and innovative systems to help maximize patient days.
Provide reliable trending analysis of current and past data related to length of stay and days authorized by specific insurance companies.
Experience working with in-network and out-of-network benefits to help maximize patient days.
Work closely with Medical team, Clinical team and Primary Therapists.
Some knowledge of all continuums of care, including admission assessment and continued stay criteria.
Ensure quality and quantity of documentation in medical and clinical records for UR.
This job description is not designed to cover or contain comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

· Skills/Special Requirements:

· Ability to multi-task, demonstrate flexibility, and prioritize in a time-sensitive and often demanding environment

· Organized and detail-oriented

· Ability to manage time effectively

· Ability to work with minimal supervision

· Proficient in Excel, Word, and electronic charting.

· Engages in appropriate written and verbal communication with families, insurance companies, and other professionals.

· Active License or Credential in a healthcare, social services, or human services field is preferred.

· A minimum of one year experience working with the Utilization Review process is required.

· Experience in Behavioral Health Care and knowledge of the ASAM criteria

· Expertise in Psychiatric and Addiction Disorders

· Substance addiction or related field: 1 year (Required)

· Working with insurance providers/claims: 1 year (Required)

· Education and Experience:
Associates Degree, Bachelor's degree preferred
3 years' experience in substance abuse or related field
Excellent organizational skills with the ability to prioritize workload
Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint

Job Types: Full-time, Part-time

Pay: $50,000.00 - $68,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Ability to Commute:

• Phoenix, AZ 85085 (Required)

Ability to Relocate:

• Phoenix, AZ 85085: Relocate before starting work (Required)

Work Location: In person

Salary : $50,000 - $68,000