What are the responsibilities and job description for the Utilization Assistant position at Wooded Glen Recovery Center?
Utilization Assistant - Addiction Recovery | Wooded Glen Recovery Center | Henryville, Indiana
About the Job:
Support Clinical Teams. Protect Patient Access. Ensure Quality Care.
Join a mission-driven team dedicated to supporting individuals on their recovery journey. As a Utilization Review Specialist, you will play a vital role in ensuring patients receive the appropriate level of care while helping the facility maintain compliance, accuracy, and strong payer relationships.
Roles and Responsibilities:
Education & Experience
- High School Diploma required.
- Bachelor's degree in Social Work, Addiction Counseling, or a related health field preferred.
- 1 year of direct clinical experience in a substance abuse setting and familiarity with ASAM criteria preferred.
Essential Functions
Insurance Verification & Pre-Certification
- Assist the Admissions Department with pre-certification of care.
- Perform pre- and post-admission benefit verification with managed care organizations.
- Ensure all insurance benefits are verified accurately and in a timely manner.
Clinical Review & Documentation
- Review client medical records to determine appropriateness of level of care at admission and throughout treatment.
- Conduct timely and interactive reviews with insurance payers to secure authorization of care.
- Maintain accurate, organized documentation and files related to utilization management.
Communication & Collaboration
- Participate in daily treatment team meetings to keep all disciplines informed of client insurance status and needs.
- Communicate UR or quality concerns to the supervisor promptly for resolution.
- Coordinate findings with the Business Office to identify or resolve potential payment issues.
Payer Interaction & Research
- Respond professionally to telephone and online inquiries.
- Research insurance guidelines and apply admission and continued stay criteria (including ASAM, when applicable).
We seek talent, qualified employees regardless of race, gender/sex, including pregnancy, gender identity and expression, national origin, religion, sexual orientation, disability, age, marital status, veteran status, or any other protected classification under state or federal law. We are proud to be an Equal Opportunity Employer.
**Veterans and military spouses are highly encouraged to apply. SummitBHC is dedicated to serving veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served**
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Why Wooded Glen Recovery Center?Wooded Glen Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Wooded Glen Recovery Center is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.