Utilization Review Analyst - Full Time
Job Posting for Utilization Review Analyst - Full Time at NUWAY
Position Overview
The Utilization Review Analyst will support the Utilization Review department which acts as a liaison between the clinical treatment team and third-party payers to promote appropriate treatment services, documentation practices and billing integrity for SUD treatment. The Utilization Review Department position ensures system integrity through the treatment continuum from clinical to claims management. Utilization Review Analysts work in a team environment and collaborate with each other to support the department’s responsibilities within NUWAY Alliance as well as other members of the team. This position will also work in conjunction with other departments within the organization to support improvement in the overall quality, completeness and accuracy of medical record documentation.
This position allows for a hybrid workplace, utilizing a telecommute work environment. The Utilization Review Analyst must be able to maintain client confidentiality in accordance with state and federal guidelines and HIPAA requirements.
Responsibilities
- Audit documentation across NUWAY Alliance programs to substantiate appropriate clinical documentation practices, inclusive of providing data and feedback to staff and leadership about patterns, trends and gap analysis
- Collaboration with Admissions and Clinical teams to identify clients entering treatment programming to determine funding
- Secure funding for client’s admitting into NUWAY Alliance programs and documents approved funding source with approval units and/or dates
- Complete documentation to support extension of funding for programming services, while reviewing medical necessity criteria
- Develop and maintain efficient processes related to client funding, including prior authorizations and concurrent reviews for third party payors
- Facilitate communication with Clinical teams to obtain appropriate clinical documentation to ensure that clinical documentation reflects the level of service rendered to clients is complete, accurate and medically necessary
- Communicate data related to insurance payers, denials and extension requests in a clear and timely manner
- Maintain current information about third party criteria for reimbursement and establish and maintain relations with payers to promote positive and direct communication
- Support all Medical Records Requests from third party payers
- Serve cross-functionally with Clinical teams, Leadership and Billing/Revenue Cycle teams, as well as other internal teams to assist in identification of overpayments
- Support the execution of internal controls to prevent issues with billing, documentation and other processes as applicable
- Maintain positive and open communications NUWAY Alliance staff, departments and leadership
- Conduct oneself in a manner that presents a positive reflection of professionalism, as an asset to the image of the organization
- Other duties as assigned or required
Competencies
- Support the Clinical teams with regulation and standard implementation and understanding of the utilization review process
- Utilize clinical knowledge and licensure to support utilization review activities of the organization
- Understand and apply the importance of self-awareness in one’s personal, professional, and cultural life
- Provide services appropriate to the personal and cultural identity and language of the client and other professionals
- Understand the treatment modalities and clinical application to practice at NUWAY to support effective training resources
Qualifications, Skills, Knowledge and Experience
Required:
- Bachelor’s degree with a major or concentration in a related field
- Current LADC license required
- Age 18 or older
- Clinical documentation integrity, clinical quality improvement, utilization review, discharge planning, or case management experience of at least one year
- At least 1 year of providing Substance Use services in an individual and group counseling setting
- Knowledge of ICD-10 and DSM-5
- Able to pass Minnesota DHS background study
- Must be free of problematic substance use for at least two years immediately preceding employment and must sign a statement attesting to that fact
- High degree of computer literacy including experience using an electronic health records (EHR) system
- Excellent written, communication, customer service, and case management skills
- Ability to relate to people from diverse backgrounds
- Demonstrated working knowledge in the field of substance use disorder and/or mental health, in an addiction treatment facility
- Physical Demands: Sitting for extended periods of time. Daily use of general office and/or residential facility equipment. Lifting (max 25 pounds), minimal reaching, bending and stooping. Ability to effectively navigate program or office environment such as ascending and descending steps, passing through doorways and entrances, and accessing program/office facilities.
Preferred:
- Minimum of 1 year experience performing utilization review tasks
- Strong analytical and problem-solving skills
- Strong facilitation, negotiation, investigation and mediation skills
Salary.com Estimation for Utilization Review Analyst - Full Time in Saint Paul, MN
$76,159 to $99,570
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