Utilization Review

ABOUT US:
Balance Treatment Programs are leading the way in comprehensive mental health care. Our mission is to improve the lives of individuals, their families and members of their larger communities by addressing the issues that are preventing growth. We strive to ensure our programs remain responsive to the demands of the nation-wide and global challenges in mental health care. Our programs provide an intensive evidence-based approach to treatment. We are accredited by the Joint Commission and are dedicated to maintaining the utmost level of integrity in our programs. We value a strong and passionate team, able to share their diverse contributions. We support an environment for growth that is inspiring, warm, collaborative, ethical and professional.

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BENEFITS: *
We are a strongly connected staff committed to each our own well-being, as well as a comprehensive approach to the care of our clients. Our leadership team is lead by employee feedback and committed to employee retention and career growth. Position has robust growth potential.

• Competitive benefits package (health insurance, dental, vision, life insurance)
• 30 hours eligible for full benefit package

• 401K with employer match up to 4% for all full and part time employees
• Six paid holidays annually

POSITION:
We are currently seeking to fill the position of Utilization Review. This team member will be responsible for ensuring medically appropriate, high quality, cost effective care for clients throughout the utilization review process. Reports to the Utilization Review Lead.

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RESPONSIBILITIES: *

• Maintain the well-being of clients and the integrity of the program.
• Maintain comprehensive knowledge of and provide detailed information about the various programs and services the company provides in order to be able to best serve all client needs.
• Conduct prospective, concurrent and retrospective reviews as required by networks, utilizing telephonic information, medical records and/or faxed medical information and establish single cases as necessary.
• Contact clients for additional information.
• Maintain comprehensive knowledge of insurance verification process.
• Verify benefits for potential clients through phone and online platforms and ensure benefits are current for existing clients.
• Review information from potential clients to assess level of care or program.
• Conduct assessments of clients at the time of admission and re-assessments as required to determine appropriate level of care and enroll clients in treatment.
• Participate in treatment planning with purpose of obtaining information necessary for reviews.
• Participate in case conference reviews.
• Maintain an understanding of the review relationship to discharge planning and case management.
• Identify the need for intervention by other managed care resources, including case management/discharge planning, in a timely manner.
• Maintain confidentiality of clients and proprietary information. Maintain clear understanding of HIPAA rules and ensure compliance throughout the department.
• Identify and notify the insurance networks of any potential quality of care issues.
• Maintain logs and data bases for utilization management, fiscal management, care coordination activities and performance improvement measures.
• Complete all required paperwork for intake and discharge procedures.
• Maintain appropriate and timely documentation as required.
• Communicate as identified per policy to clinical and administrative team throughout authorization process.
• Assist in the orientation of new staff, providing education and support for new and current staff.
• Attend and complete all in-service training and educational workshops.
• Attend all required staff meetings and trainings.
• Maintain knowledge of and act in accordance with Balance Treatment Center mission and philosophy.
• Maintain knowledge of and act in accordance with current legal standards pertaining to professional practice, reporting requirements, professional boundaries, and related issues.
• Demonstrate respect for cultural and lifestyle diversities of clients and staff.

QUALIFICATIONS:

• A minimum of 2 years of experience in utilization review is preferred.
• Excellent oral and written skills.
• Must have knowledge of insurance verification and pre-certification procedures.
• Must have solid understanding of mental health care setting.
• Must have strong analytical, organizational, time and data management as evidenced by capacity to prioritize multiple tasks and components and compile spreadsheet data.
• Must have strong computer skills.
• Requires some travel between centers.
• Ability to work collaboratively and communicate effectively.
• Must have valid California driver’s license and liability insurance if driving personal and/or company vehicle on Balance Treatment Center business.
• Vision, hearing, manual dexterity and hand-eye coordination must be adequate for performance of job duties. Able to sit at desk, use keyboard, write and physically perform other job duties. Able to move about the facility to observe clients and staff.
• Must be customer-service driven.
• Specific qualifications may vary based on assignment.

We are an Equal Opportunity Employer committed to providing a fair and inclusive work place.
Competitive benefits program and strong potential for growth.

We strive to provide our team a chance to learn, a chance to teach, a chance to listen, a chance to serve, a chance to work for and to witness victories.

Helping everyone grow!

Job Type: Part-time