Utilization Review Specialist

Overview

Job Title Utilization Review Specialist Job Description We have a clinical, interdisciplinary team approach that focuses on excellence in all areas of care. We are also passionate about enhancing traditional inpatient/outpatient programs with holistic services and about helping the entire family, not just the patient, stay educated and informed. The Utilization Review Specialist (UR Specialist) is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews for the duration of patient’s treatment stay, and assists the treatment team in understanding the different requirements that various insurance companies have for admission, continued stay, and discharge planning. This position assists the team in utilization review and behavioral health billing. The Utilization Review Specialist is responsible for organizing and coordinating Utilization Review activities within the facility in accordance with standards of State and Federal regulations, accreditation standards, and payor guidelines. Required skills & experience (the “must haves” to be considered) • Active License or Credential in a healthcare, social services, or human services field is preferred. • State license preferred (e.g., Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor). • Bachelor’s degree in Social Work or LPN license issued by NC Board of Nursing preferred • At least three (3) years’ experience working in utilization review, preferably in a Psych or chemical dependency setting. • Experience in Behavioral Health Care and knowledge of the ASAM criteria • Expertise in Substance Use Disorders • Proficient in Excel, Word, and electronic charting. • Engages in appropriate written and verbal communication with families, insurance companies, and other professionals. What you need to know - This is an opportunity to join a new practice and be a fundamental part of developing and scaling something new and progressive. - This organization exists to provide the kind of family-focused, evidence-based therapy that isn't currently available in the area. It's an opportunity to make a lasting difference in the lives of clients struggling with addiction.

Benefits

Company

We are the premiere treatment provider offering a unique, family focused, comprehensive, and individualized program for chemical dependence. Excellence focused, clinically focused, safety and trauma focused, family focused to clients who meet the clinical and medical criteria for services.