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Form of workJob Description
We're looking for experienced Utilization Review Specialist that has worked in substance abuse industry for years to perform daily audits of clinical documentation.
Responsibilities
-The Utilization Review Specialist is responsible for daily review of clinical documentation of our clinical team to make sure all is complete and compliant with state regulations and requirements.
-Daily reporting of review findings to management via spreadsheets and internal audit portal.
- Ongoing communication with our clinical team staff with instructions and directions of what is needed from them.
- Proficiency in Kipu EMR
- Initiate and resolve UR appeals when needed.
- Ensure EMR is up to date and accurate in regards to UR
- Work closely with clinical team to ensure continuity and quality of care for clients
- Utilize ASAM criteria to identify and advocate for appropriate level of care placement
- Monitor clinical documentation to insure appropriate, timely and effective provision of services and treatment planning
- Ensure that all insurance information needed for billing and collection processes are obtained and recorded appropriately in the EMR system
- Maintain confidentiality pertaining to clients and families
- Any other duties as instructed by management
- Acquire and maintain all CEU, CPR, trainings, etc. as required by DCF and JCAHO
This is immediate opening, if interested please apply right away by sending your resume. Thank you
