Utilization Review Specialist (Behavioral Health) - ON HOLD
Type: Part Time
Scope
The Utilization Review Specialist (Behavioral Health) proactively monitors appropriate utilization of services and optimizes reimbursement. Responsible for communicating client specific clinical information to external reviewers for the purposes of obtaining continued stay authorization.
Duties:
- Perform ongoing utilization reviews (concurrent reviews) and documentation
- Work independently in gathering information for reviews from the client record and other treatment team members such as primary counselors
- Prepare and submit clinical information to MCOs, effectively coordinating collection of all pertinent data to support Skyland Trail and client's position
- Coordinates peer reviews with Primary Counselors or Psychiatrists as needed.
- Maintain and update logs of review and maintain other appropriate UR records
- Assists with medical records maintenance duties as needed
- Stay abreast of applicable UR trends
- Other duties as assigned
Core Competencies:
- Negotiation Skills
- Joint Commission/HIPAA Standards
- Managed care (verification, negotiating rates, and pre-certification)
- Knowledge of emergency procedures for fire, disaster and unplanned incidents
- Medical Records documentation requirements
- Medical Records confidentiality and disclosure laws
- Clinical skills
- Computer skills
Reports to:
Utilization Review Coordinator
Proficiencies
Candidate must demonstrate interpersonal management with a high level of written and verbal communication skills. Candidate will interface regularly with medical and behavioral health staff, clients, families and various managed care companies. Time management skills are a must.
Qualifications
- Bachelor's Degree in counseling, social work, or other human services field.
- A minimum of 2 years experience in a behavioral health setting such as an outpatient center, residential treatment facility or psychiatric hospital is required.
