Utilization Review Specialist

Overview:

This position reviews clinical documentation to screen for appropriateness of ASAM admission, continued stay criteria, regarding delivery of care, treatment, and services. Utilization Review Specialists also confirm insurance eligibility, prepare reports, and actively participate in continuous quality improvement, as deemed appropriate.

Education:

Completion of a Bachelor’s Degree in social work, psychology, SUD, or related field from an accredited college or university OR equivalent combination of education and experience.

Responsibilities:

• Conduct thorough reviews of clinical documentation to ensure compliance with payer requirements and standards for substance abuse services.
• Collaborate with treatment teams to gather necessary information and advocate for the appropriate level of care for our clients.
• Interface with insurance companies to obtain pre-authorizations, concurrent reviews, and appeals for denied services while collaborating with our billing department.
• Provide expert guidance on utilization review processes, payer requirements, and evidence-based practices for substance abuse treatment.
• Assist in developing and implementing policies and procedures to enhance the efficiency of the utilization review process and ensure compliance with federal, state, and payer regulations.
• Maintain up-to-date knowledge of changing regulations and policies related to substance abuse reimbursement.
• Support the billing department by providing accurate and timely clinical information to facilitate the billing process.

Job Types: Full-time, Contract

Pay: $24.56 - $25.08 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

People with a criminal record are encouraged to apply

Education:

• High school or equivalent (Preferred)

Experience:

• Completing ASAM reviews: 2 years (Required)
• SUD treatment facility: 2 years (Preferred)
• Utilization reviewer: 2 years (Preferred)

License/Certification:

• ASAM certified (Required)

Ability to Relocate:

• Emlenton, PA 16373: Relocate before starting work (Required)

Work Location: In person