JOB DESCRIPTION

The primary goal is to monitor adherence to the facility’s utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility  admissions and extended facility stays.

Job Classification: Non Exempt Hourly        Reports To: Senior RCM Director

Supervisory Responsibilities:   None.

JOB DUTIES:

• Completes Initial, concurrent, peer reviews, and expedited appeals in a timely manner to ensure continuous coverage.
• responsible for all aspects of the authorization of treatment via insurance and managed care companies.
• 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 facilities in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.
• Represents the company in a positive manner per the Professional Standards of Conduct
• Protects the confidentiality of patients and the privacy of staff
• provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
• Uses a computer to type correspondence, reports and other items as requested,
• Experience in the Mental Health/Addiction space, May be a fully licensed SUDC, CAC,LADC, LCSW, CMHC or RN
• Additional duties as assigned.

MINIMUM QUALIFICATIONS

• Bachelor’s or Master’s degree in Behavioral/Mental Health Field (or related experience) preferred
• A minimum of 3-5 years experience doing utilization review is required preferred
• Expertise in psychiatric and addiction disorders
• Experience interacting effectively with co-workers as well as clients.
• Experience maintaining confidentiality in accordance with HIPAA and company policy requirements.

Required Skills/Abilities:

• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Proficient with Microsoft Office Suite or related software.

PHYSICAL REQUIREMENTS

• Prolonged periods sitting at a desk and working on a computer.

Remote Position

Benefits:

• Competitive salary

• Health, dental, and vision insurance

• 401(k) with company match

• Paid time off and holidays

• Continuing education and professional development opportunities