Branch Review Specialist conducts branch internal audits to determine whether business controls are sufficient and effectively executed in accordance with bank policies and procedures. Tests established procedures to ensure operational efficiency within branch offices. Being a Branch Review Specialist determines whether branches are performing their planning, accounting, custodial, or business control activities in compliance with management instructions, policies, and procedures. Evaluates functions and activities in assigned areas to determine the nature of operations and the adequacy of systems to achieve established objectives. Additionally, Branch Review Specialist recommends corrective actions and improvements. Requires a bachelor's degree. Typically reports to a supervisor or manager. The Branch Review Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Branch Review Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
Job Summary: Conduct pre-certification and utilization management functions for all behavioral health and substance abuse services offered by the Brattleboro Retreat. Engages in ongoing contact with managed care company representatives to provide initial clinical data for pre-certification and concurrent case review to ensure authorization of all necessary days at the most appropriate level of care. Conducts concurrent chart and retrospective review as requested by the Director of Utilization Management and Contracting. Communicates information to clinical staff, physicians, and fiscal services regarding days/services approved, information required for ongoing review, review schedule, denial of stay, and, coordination of Physician to Physician review, and/or appeals
QUALIFICATIONS:
1. Working knowledge of level of care criteria.
2. Working knowledge of regulatory agencies preferred.
3. Working knowledge of insurance and managed care companies preferred.
4. Excellent written and verbal communication skills, flexibility, strong team member and ability to establish positive working relationships with a variety of clinical staff.
5. Clinical knowledge.
6. Bachelor’s degree in related field preferred.
7. Two years’ experience working in behavioral health field, hospital setting preferred.
8. Experience with computers, data entry; and, Microsoft Office.
9. Excellent organizational and time management skills.
10. Possesses the ability to work under pressure while maintaining proper composure and a professional demeanor.
11. Experience and proficiency with Avatar required.
12. Experience with McKesson InterQual preferred.
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