Utilization Review Specialist

Ascend Healthcare is searching for patient, compassionate, and caring people looking to work with teens in an Adolescent Residential Treatment Center.

The Utilization Review Specialistis responsible for managing an active caseload of clients at the following Levels of Care: Residential and Partial Hospitalization. S/he acts as a liaison between insurance companies, the client, the client’s family, and the Clinical Team. The Utilization Review Specialist is responsible for gathering required information, effectively case-building, and collaborating consistently with members of the interdisciplinary Treatment Team to ensure optimization of each client’s coverage and benefits. Maintains contact with the clients’ families and keep them updated on current insurance authorization updates, Peer Reviews, and Denials.

JOB DUTIES AND RESPONSIBILITIES

− Complete Initial, concurrent, Peer, and retrospective reviews in a timely manner to ensure continuous coverage.

− Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.

− Document all activities in a detailed manner in applicable CRM/EMR

− Collaborate with Clinicians and the multidisciplinary team daily at the Residential Programs in order to obtain necessary clinical documentation for reviews and ensure effective utilization of resources

− Reviews and prepares Appeal documentation (including rationales) to the appropriate entities as indicated

− Coordinate, schedule, and complete Peer-to-Peer and Appeal reviews

− Complete weekly Treatment Team notes and provide updates to the Psychiatrist as requested by the Director/ Manager

− Represents the UR Department in a professional and positive way to other Departments and the company as a whole.

− Consistently demonstrate excellent communication, prioritization, and multi-tasking skills

− Maintains contact with the clients’ families and keep them updated on current insurance authorization updates, Peer Reviews, and Denials

− Participate in weekly Treatment Team and Continuing Care Meetings as appropriate

EDUCATION AND SKILL REQUIREMENTS

− Master’s degree in behavioral health Field

− Current MFT, LCSW, LPCC, PsyD, or PhD in the state of California

− At least 2 years of work experience in the behavioral health field

− CollabMD experience preferred

− Excellent communication skills

− Proficiency with Excel, EMR software, and RCM software preferred

− Organized

Job Type: Full-time

Pay: $70,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• behavioral health: 1 year (Preferred)
• Collaborate MD: 1 year (Preferred)
• Kipu: 1 year (Preferred)

License/Certification:

• MFT, LCSW, LPCC, PsyD, or PhD (Required)

Work Location: Remote