The Utilization Review Specialist is responsible for organizing and conducting concurrent reviews with all insurance carriers. Daily task are (but not limited to): Conducting prior authorizations and continued stay reviews with insurances while utilizing ASAM criteria to determine medical necessity for each level of care in time allotted. UR Specialist will work closely with clinical teams and medical staff to minimize denials and facilitate optimal use of facility resources.

Requirements:

• Gather necessary information from medical record to complete a utilization review, continued stay, or prior authorization.
• Have a working relationship between clinical teams and medical staff to effectively complete reviews.
• Complete discharge and change in level of care reviews.
• Audit charts for compliance
• Update and work within KIPU EMR

Skills, knowledge, and abilities required:

• Excellent customer services skills
• Ability to adapt with changing work flow
• Maintain highest level of regard to HIPAA
• Must be available Monday through Friday 8am to 5pm EST.

Qualifications

• Minimum of 2 years of experience in a behavioral health, inpatient setting with equal experience in utilization/ clinical review.
• Must be organized, detail oriented, able to work independently with minimum supervision.
• Excellent communication and time management skills.
• Ability to prioritize tasks and act as a team player. Good attendance is essential.
• Computer proficiency is necessary.
• Proficency in ASAM guidelines.
• Working knowledge of billing practices.

The Utilization Review Specialist will Collaborate with BriteLife facilities regarding Utilization Review (UR) and ensures that all clients are authorized for treatment at the appropriate level of care in a timely manner. The UR Specialist serves a dual function ensuring quality and comprehensive charting of all services rendered by maintaining collaborative lines of communication with facility leadership.