Utilization Review Specialist (Remote)

Utilization Review Specialist/Behavioral Health Substance Abuse

Responsibilities and Duties:

• Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive manner in the professional Participate in staff meetings as needed

• Clear communication with supervisors, co-workers, and facilities
• Keeps abreast of changes to, and monitors compliance with, State and Federal laws and regulations in areas of insurance/ third party payers
• Protects the confidentiality of patients and the privacy of staff
• Uses a computer to type correspondence, reports and other items as requested, ensuring that typing is accurate
• Process data in conjunction with compliance consultant in order to present it effectively using established statistical methods
• Demonstrates the willingness to accept responsibility

• Performs other duties as assigned by the Director of Utilization Review

Skills and Competencies:

• Prior Utilization Review experience in a Substance abuse environment is mandatory.

• Knowledge of ASAM guidelines.
• Knowledge of accreditation and licensure requirements (RN, LCSW, LPN, LMFT) in accordance with state agencies.
• Ability to establish rapport with and supervise employees as well as professional staff and peers
• Ability to work under stressful conditions and is flexible in relation to department needs.
• Knowledge of medical terminology.
• Demonstrates proficiency in Verbal & Written Communication
• Skills.
• Knowledge of State & Federal Statutes Regarding Patient Confidentiality Laws.
• Knowledge of Drug-Free Workplace Policies. Knowledge of Corporate Integrity & Compliance Program.
• Knowledge of state guidelines and accreditation agency standards
• KIPU experience required, Best Notes experience a plus

• Ability to lift a minimum of 20 lbs.

Requirements/Qualifications:

Some positions may require a certain level of education, related work experience, knowledge, skills, abilities, licensures, certification and/or other job related requirements.

• Prior Utilization Review experience in a Substance abuse environment is mandatory.

• BA in Psy. min. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator).