Utilization Review Specialist

45 minutes ago
Full-time
Mid Level
Operations
The Recovery Village Drug and Alcohol Rehab

The Recovery Village Drug and Alcohol Rehab

The Recovery Village Drug and Alcohol Rehab is a national network of addiction treatment centers with state-of-the-art facilities in multiple states. They offer comprehensive treatment for dual diagnosis-based drug and alcohol rehab, mental health trea...

Health Care Providers & Services
51-250
Founded 2013

Description

  • Contact external case managers and managed care organizations to obtain pre-authorizations and concurrent reviews throughout the patient stay.
  • Complete pre-authorizations, concurrent reviews, and internal utilization review reviews.
  • Consult with multidisciplinary treatment team members to gather required information for concurrent reviews.
  • Schedule peer-to-peer reviews and coordinate urgent or expedited appeals.
  • Staff individual cases with physicians as needed.
  • Follow all Advanced Recovery Systems utilization review policies and procedures.
  • Use the UR Census Report daily to track caseload activity.
  • Make initial calls within 24 hours and follow up every 24 hours.
  • Enter data, manage records, and support the appeals process.
  • Complete detailed daily documentation and communicate frequently with the treatment team.
  • Work with the Finance Department regarding client service authorizations.
  • Perform other assigned duties as needed.

Requirements

  • Bachelor’s degree in a health or behavioral health-related field required.
  • Graduate degree in a health or behavioral health-related field preferred.
  • High school diploma or equivalent plus a state license such as RN, LPN, LCSW, or LMHC is preferred.
  • Minimum of 3 years of experience working in a psychiatric or chemical dependency setting.
  • Minimum of 3 years of utilization review experience preferred.
  • State licensure preferred, including Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, or Licensed Mental Health Counselor credentials.
  • Proficiency in communicating effectively with managed care companies.
  • Ability to align medical and counseling staff to ensure timely, appropriate levels of care in compliance with governmental and accrediting agencies.
  • Knowledge of concurrent reviews, utilization review, Census Report processes, and ASAM criteria.
  • Ability to be resourceful and proactive in resolving issues.
  • Strong organizational skills with the ability to multitask, prioritize, and work under pressure.
  • Effective time management skills.

Benefits

  • Starting pay of $50,000 per year, based on experience.
  • Up to 2 weeks of paid time off per year, plus sick pay and holiday pay.
  • Benefits begin on the first day of the month following hire.
  • Matching HSA with up to $1,500 per year contributed by the company.
  • 401(k) plan.
  • Medical, dental, and vision insurance.
  • Free Telehealth access.
  • Employee referral bonus of up to $4,000.

Interested in this position?

Apply directly on the company website

Apply Now

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