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Utilization Review Specialist

4 months ago

Santa Ana, United States NEW LIFE TREATMENT CENTER Full time
Job DescriptionJob Description

We're looking for experienced Utilization Review Specialist that has worked in substance abuse industry/mental health for years. Almost 90% of our authorizations are for in network policies so we prefer someone that has experience in this field and working with KIPU EMR.

Responsibilities

-The Utilization Review Specialist is responsible for utilization management for both incoming clients as well as current clients

- Complete assessments and pre-certification

- Complete utilization, discharge and peer reviews

- Initiate and resolve appeals

- Ensure EMR is up to date and accurate in regards to UR

- Work closely with clinical team to ensure continuity and quality of care for clients

- Utilize ASAM criteria to identify and advocate for appropriate level of care placement

- Monitor clinical documentation to insure appropriate, timely and effective provision of services and treatment planning

- Ensure that all insurance information needed for billing and collection processes are obtained and recorded appropriately in the EMR system

- Maintain confidentiality pertaining to clients and families

- Any other duties as instructed by management

- Acquire and maintain all CEU, CPR, trainings, etc. as required by DCF and JCAHO

Job Type: Full-time

Good Pay, bonuses, flexible hours, fully remote and working from comfort of your home

This is immediate opening, if interested please apply right away by sending us your resume. Thank you.

Company DescriptionWe are Substance Abuse Treatment Center with ALL levels of care located in Santa Ana, Ca.Company DescriptionWe are Substance Abuse Treatment Center with ALL levels of care located in Santa Ana, Ca.