Utilization Review Clinician

Grow with us!

Utilization Review Clinician

Monte Nido

Remote 

Monte Nido has been delivering treatment for eating disorders for over two decades. Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

We are seeking a Utilization Review Clinician to join our team based Remotely.

This is a Full-Time remote position working CST/MST hours.  

The Utilization Review Clinician is responsible for conducting all utilization reviews, peer reviews, and pre-certifications in a well formulated and comprehensive manner, documenting these reviews, and coordinating with both the on-site clinical team, admissions, verifications, and billing regarding clients’ insurance status.  

#LI-REMOTE

Total Rewards:

Discover a rewarding career with us and enjoy an array of comprehensive benefits! We prioritize your success and well-being, providing:

• Competitive compensation
• Medical, dental, and vision insurance coverage (Benefits At a Glance)
• Retirement
• Company-paid life insurance, AD&D, and short-term disability
• Employee Assistance Program (EAP)
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Paid time off
• Professional development
• And many more!

We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Responsibilities Include:

• Complete and manage all authorizations for designated programs & departments including prior authorization, continued stay, change in level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals.
• Engage in clinical rounds as an active treatment team member providing payor feedback and needs for next review, guidance on level of care recommendations, and feedback on what will be needed for authorization of clinically indicated services.
• Support treatment team members & Admissions by discussing services covered by the members benefits and reviewing clinical documentation needed to advocate with our client’s insurance most successfully.
• Communicate with billing regarding billing/claims issues and status of single case agreements as needed.
• Effectively communicate with program leadership, clinicians, and admissions regarding status of client authorization, potential denials, and potential for private payment.
• Follow workflow and medical record requirements for utilization review and clinical documentation across programs.
• Leverage understanding of medical necessity criteria and current behavioral health insurance landscape in verbal and written communications with payors to maximize our clients’ access to care and decrease peer to peer reviews.
• Communicate emerging trends with insurance companies to Director of Utilization Management.
• Maintain database of insurance company clinical care guidelines, APA guidelines, medical necessity criteria and other necessary documents and clinical ammunition to support UR process.
• Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff diversity.
• Seek corrective criticism and evaluate suggestions objectively.
• Maintain acceptable overall attendance.
• Promote a favorable/positive work atmosphere.
• Attend in-services and educational training as necessary and as assigned.
• Seek out learning experiences and incorporate new knowledge into practice.
• Maintain flexibility and adaptability to expected and unexpected changes in the work environment.
• Report incidents, accidents, and occurrences in accordance with policies and procedures.
• Maintain safety of the physical environment.
• Comply with facility policies and procedures.

Qualifications:

• Master’s Degree in Psychology, Social Work, Nursing, Nutrition, or mental health-related field required
• At least one year of experience relating to insurance authorizations and managed care.
• Experience providing direct care to individuals with an eating disorder preferred.
• Licensed behavioral health clinician/provider, RD, or RN

#montenido