Utilization Review Coordinator jobs in Spofford, NH

Job Description

Job Description

Utilization Review Specialist / Behavioral Health Substance Abuse

FLSA Status : Exempt

Classification : Full-Time

Reports To : The UR Specialist will report to UR Manager.

Job Overview : The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.

The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.

The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.

Responsibilities and Duties :

Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive manner in the professional Participate in staff meetings as needed

Clear communication with supervisors, co-workers, and facilities

Keeps abreast of changes to, and monitors compliance with, State and Federal laws and regulations in areas of insurance / third party payers

Protects the confidentiality of patients and the privacy of staff

Uses a computer to type correspondence, reports and other items as requested, ensuring that typing is accurate

Process data in conjunction with compliance consultant in order to present it effectively using established statistical methods

Demonstrates the willingness to accept responsibility

Performs other duties as assigned by the Director of Utilization Review

Skills and Competencies :

Prior Utilization Review experience in a Substance abuse environment is mandatory.

Knowledge of ASAM guidelines.

Ability to establish rapport with and supervise employees as well as professional staff and peers

Ability to work under stressful conditions and is flexible in relation to department needs.

Knowledge of medical terminology.

Demonstrates proficiency in Verbal & Written Communication

Skills.

Knowledge of State & Federal Statutes Regarding Patient Confidentiality Laws.

Knowledge of Drug-Free Workplace Policies. Knowledge of Corporate Integrity & Compliance Program.

Knowledge of state guidelines and accreditation agency standards

KIPU experience required, Best Notes experience a plus

Requirements / Qualifications :

Some positions may require a certain level of education, related work experience, knowledge, skills, abilities, licensures, certification and / or other job related requirements.

Prior Utilization Review experience in a Substance abuse environment is mandatory.

BA in Psy. min. Three to Five (5) years experience in Case Management / Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, Case Manager, or Utilization Review Coordinator).

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.