Utilization Review Specialist

2 weeks ago

Tucson, United States Amity Foundation Full time
Job DescriptionJob Description

Amity Foundation an internationally acclaimed teaching, and therapeutic community is seeking compassionate and enthusiastic individuals with a desire to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ. With this groundbreaking opportunity not only will you be working with our home offices, but you will also be enhancing your training and experience in the field and supporting the growth of our community

 

About Amity

Amity Foundation is a safe place where people can change in an environment that fosters trust; where new values can be formed; responsibility developed, and lasting relationships built. Amity is dedicated to the inclusion and habilitation of people marginalized by addiction, homelessness, trauma, criminality, incarceration, poverty, racism, sexism, and violence. Amity is committed to research, development implementation, and dissemination of information regarding community building

Remembrance, Resolution, Reconciliation, Restoration, Renewal

 

About the Position

Utilization Review Specialist you will contribute to the organization by providing vital support to the community by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective utilization management-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported.

 

What You Will Do:

  • Collaborates with Admissions to ensure the compliance of new enrollment authorization of clients ("students") into the program.
  • Working with the enrollment department on ensuring that all new enrollments have the correct paperwork needed for authorization.
  • Upload and track paperwork of corresponding AHCCCS approvals and/ or requests for more information.
  • Conducting and Completing Level of Care interviews for new enrolling students. Creating and documenting the progression of care as determined by the DSM V.
  • Accurately document the medical necessity and level of care based on evidence-based criteria.
  • Detailed charting and accurately documenting students' conditions, criteria, medical necessity, risks, etc.
  • Determining if the medical necessity for admission is appropriate, justifiable, and reimbursable.
  • Completing concurrent utilization reviews for continued approval of authorizations.
  • Communicating with the home office and UR1 each student's level of care each student and determining the frequency of future reviews.
  • Completing and updating student treatment plans. Uploading treatment plans and required paperwork to the AHCCCS and Amity Foundation databases.
  • Maintaining a detailed spreadsheet listing when paperwork is submitted and what is needed for authorizations.
  • Utilize negotiation skills, which effectively promote constructive solutions
  • Attend daily meetings with the team to ensure open communication and all tasks are getting completed.
  • Other duties as assigned by supervisor.

 

What You Will Bring:

  • Hands-on knowledge of medical/behavioral health terminology.
  • High School diploma or GED.
  • Relevant accounting experience required. 3-5 years preferred
  • Analytical and problem-solving skills.
  • Excellent interpersonal communication, problem-solving, and conflict resolution skills.
  • Computer skills in word processing, database management, and spreadsheet desirable.
  • Proficiency with MS Office, including Word, Excel, and Outlook.

 

What We Offer:

  • 100% Employer-Sponsored HMO Medical.
  • PPO, Dental & Vision options.
  • Paid Vacation, Sick time, & Holidays

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