Utilization Review

Health Care Alliance North America
Asheville, NC Other
POSTED ON 11/18/2022 CLOSED ON 3/27/2023

Job Posting for Utilization Review at Health Care Alliance North America

Are you interested in a fulfilling career within the addiction and recovery industry? Do you long to improve the lives of others? If so, we have good news! Health Care Alliance NA is looking for a Utilization Reviewer (UR)  to join our team! The UR team works with all departments to compile medical necessity information and relays this to insurance companies, making sure that client’s care is covered. UR helps ensure that the services provided are in accordance with Health Care Alliance's policies and procedures, standard operating procedures, philosophy, objectives, and mission statement.  


About HCANA:

Health Care Alliance North America (HCANA) is a rapidly expanding healthcare management company specializing in addiction and mental health treatment. It was founded by individuals in recovery who have first-hand experience in receiving addiction treatment and have developed a specialized model of care that incorporates techniques that work while eliminating those that do not. Although the company is growing and expanding, HCANA maintains the mindset of a small business, with every employee being considered family. We promote a healthy work/life balance for all employees while maintaining our focus on providing excellent care within a fun, calming environment for clients and staff alike.


Qualifications
1. Education – Bachelors level preferred or (related experience in substance abuse field.
2. Experience - Minimum of 1 year of direct clinical experience is preferred.
3. Certifications - Certification as an alcohol and drug counselor preferred (CSAC)
4. Special Requirements - Knowledge of alcohol and chemical dependency treatment, rehabilitation programs, and dual diagnosis experience required. Experience with ASAM criteria, LOCUS criteria, medical necessity, billing census management, direct client care.


Responsibilities include: pre-certification, obtaining authorization, census management, clinical reviews, billing census management, gathering and communicating medical/clinical necessity to insurance companies, ability to work outside of normal clinical building hours as needed, and communication with medical, admissions, clinical team, case management, and billing. Utilization Reviewer must be familiar with Levels of Care, ASAM Criteria, LOCUS Criteria specific to various insurance companies, Gmail, google calendar, Microsoft Excel, KIPU. Knowledge of the DSM5.


Essential Job Duties:
-Gathers/assesses/communicates information about: Medical/Psychological/Social factors effecting a client’s ability to recover in a specific level of care
-Manages and relays billing census to billing department
-Demonstrates knowledge of the natural history of dependence distinguishing between alcohol and other drug-related symptoms and other pre-existing physical problems or pathologic behaviors.
-Demonstrates understanding of the biopsychosocial influences and effects of dependencies.
-Demonstrates understanding of the range of treatment and interventions needed for chemically dependent or individuals struggling with mental health issues.
-Ability to determine, based on assessments, the most appropriate level and nature of treatment for the dependence or mental illness. Understands the acute and chronic nature of the dependence and the ways medical, emotional, behavioral, social, educational and other interventions are used to treat the individual.
-Ensures that all documentation regarding patient care, treatment and incidents is complete and accurate
-Conducts initial and concurrent reviews, as well as step down and discharge information.
-Completes records as required.


Complete in a clear, concise, accurate and timely manner, the following:
-Census Management

-Pre-Certification

-Approving admits via email 

-Billing Census
-Concurrent Reviews
-Stepdown/discharge information
-Attending morning clinical meeting with facilities you manage
-Meet with various departments/facilities and discuss charts/gather information
-Maintaining patient records related to screening, intake, treatment, continuing care, progress toward goals and objectives, discharge summary, and treatment outcomes that are accurate, concise, timely, and useful for coordinating treatment team planning, monitoring, and review.
-Consistently expand knowledge with updated information for ASAM/LOCUS Insurance specific criteria
-Working with clinical director to insure completeness and accuracy in any/all charts with facilities you manage
-Other duties as assigned


Schedule: Office hours 9AM-5PM, Monday-Friday (there will be work outside of these hours)

Location: On-Site, HCANA Corporate Office 


Benefits:


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



Health Care Alliance North America does not discriminate on the basis of race, color, ethnic origin, ancestry, age, religion or creed, disability, sex or gender, sexual orientation, military or veteran status, or any other characteristic protected under federal, state, or local law

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