Utilization Review Clinician

Utilization Review Clinician: Full-Time

Shift/Hours:

• Saturday, Sunday and Monday 9am - 9pm OR
• Monday through Friday 8am - 5pm

Valley Hope has an exciting full-time opportunity for an Utilization Review Clinician to join our team. This position can be performed remotely by candidates residing in cities in which Valley Hope operates.

With a near 60-year legacy of helping patients and families, Valley Hope is nationally known as a trusted provider of addiction treatment and recovery support. Since treating our first patient in 1967, Valley Hope has established a national footprint, with 16 treatment programs across the United States, with multiple locations in Colorado, Kansas, Missouri, Nebraska, Oklahoma, and Texas. We have helped more than 350,000 people find hope in recovery and restore their lives.

Our team members are passionate about and committed to working together as colleagues and with our patients to help them reclaim their lives from addiction. From clinicians to nurses, maintenance to administrative staff, and everyone in between, your work is essential to helping people find new life in recovery.

Valley Hope values our employees and works intentionally to ensure employee satisfaction, support, and professional development. Our compassionate culture, built over more than five decades, is foundational to the success of our patients and the care we provide.

EDUCATION & EXPERIENCE

Required:

• Clinical credential such as a counselor certificate or nursing license (RN or LPN).
• Three years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
• License or credential to function as an alcohol and drug treatment counselor in the state in which the Counselor is working.
• CPR/First Aid Certification

Preferred:

• Master’s degree in a behavioral healthcare related field
• Five years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.

COMPENSATION:

• Starting salary range - $64,000 - $78,000 (Based on education and experience)

BENEFITS:

• Affordable health, dental, and vision insurance
• Tuition Assistance
• Student Loan Repayment
• Public Student Loan Forgiveness (PSLF) Eligible Employer
• 8 Paid Holidays (Including 1 Personal Holiday)
• PTO – Up to 27 Days per year based on years of service
• Paid Parental Leave
• 401(k) Retirement Plan with employer match
• Health Saving and Flexible Spending Accounts
• Employee Assistance Program
• And much more!

JOB SUMMARY:

• Provide support services to review and coordinate clinical utilization and external payer expectations for each patient admission where external payment options exist.
• Serve as a clinical resource person for the health care team when determining appropriateness of admission and continued stays.
• Gather required clinical information and report to insurance company’s patient’s progress and plan to receive authorization for continued stay.
• Maximize certified patient days that are clinically appropriate and available as benefits
• Assist with insurance pre-certifications for patients who are admitted during regular shift hours and follow up on pre-certifications that are performed or initiated during off-shift hours.
• Appeal denials of certified days when it is in the best interests of both the patient and Valley Hope to do so.
• Effectively communicate patient status information with the business office, nursing, and counselor.
• Regularly review medical necessity guidelines for managed care partners.
• Communicate information to appropriate staff members to assist in discharge planning efforts
• Provide effective documentation to Valley Hope contract physicians and/or other clinical staff to assist with peer to peer reviews.
• Inform UR Manager of any ongoing trends/issues occurring with managed care companies.
• Completes any required continuing education credits.
• Maintains current state license/certification.

WORK ENVIRONMENT:

• Sitting for extended periods of time; regularly talking to and listening to others.
• Able to work at a rapid pace for long periods of time (typically no longer than 8 hours).

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