Utilization Review Supervisor

2 weeks ago

Bakersfield, United States Embark Behavioral Health Full time

Overview:

Utilization Review Supervisor

Pay: $27 - $30 per hour

The Utilization Review Supervisor will oversee a Utilization Review team to effectively implement and complete the authorization processes for Embark BH programs. The primary responsibilities for this role include building a cohesively effective UR team to ensure that they are successfully managing the timely and accurate submission of authorizations to respective payors. The role will include duties such as working closely with the various organizational department heads.

The primary responsibility for the Utilization Review Supervisor is to oversee the basic daily functions of a Utilization Review Team. The Utilization Review Supervisor is responsible to ensure all SLAs are met, KPIs are maintained, and to be a liaison between the UR Team and the stakeholders of Embark Behavioral Health. The UR Supervisor will ensure authorizations are completed timely and will also ensure all UR Reps complete regular training. They will be responsible for assisting with new program stand up and assist with training and mentoring the new program clinicians. The Utilization Review supervisor will ensure each new UR Reps is onboarded and trained appropriately. The UR Supervisor will be responsible for reviewing and/or completing all necessary appeals and engaging in denial trend reviews and root cause analysis of such with the Utilization Review Director.

The Utilization Review Supervisor must be professional, a self-starter who is able to work in a fast-pace and high-stress environment, and an individual who is self-motivate with the ability to multitask well. The purpose of the position is to ensure the success of the UR Reps, which will also ensure longevity of treatment for clients and families. This role requires a person skilled in maintaining healthy relationships, developing effective teams, and can maintain productive communication skills with a variety of professionals.

Embark Behavioral Health is a unique organization comprised of extraordinary programs dedicated to bringing the current all-time high rates of adolescent anxiety, depression, and suicide to all-time lows within the decade while becoming the most recognizable, respected, and valuable behavioral health organization in the world.

Embark is a leading network of clinical and therapeutic programs (residential treatment centers, young adult transition programs, outpatient centers, addiction treatment facilities, wilderness therapy programs, support services, and more) that offer a comprehensive set of services that run the span of acuities, ages, and services. All programs offer state-of-the-art therapeutic interventions, lead the way in quality standards, deliver measurable outcomes and are all tied together via a shared set of core values (empathy, service, trust, growth, and results).

Responsibilities:
  • Provide oversight to a Utilization Review team and actively participate in workloads to remain a subject matter expert in all things related to the department.
  • Oversee the communication and presentation structures and processes of external reviews and the effectiveness of the UR teams efforts to acquire payment for services to be rendered and or that have been rendered.
  • HR responsibilities to include recruiting, interviewing, hiring, and training of new staff; providing one-on-ones and constructive and timely performance evaluations, employee development; and handles discipline and termination of employees in in accordance with company policy.
  • Ensure all UR Reps receive regular and mandatory training both upon hire, and throughout employment.
  • Ensure assigned team achieves objectives and KPIs.
  • Assist with the standup of new programs and training of clinicians and program staff on regular intervals
  • Communicate regularly with the various treatment team providers and ensure team members are participating in Treatment Team meetings.
  • Engaging in necessary appeals and retro-reviews
  • Ensure timely SCA negotiations and executions
  • Ensure all potential clients receive appropriate certifications for services to be rendered by working closely with insurance companies, therapists, and billing department.
  • Monitor the fulfillment of all documentation requirements.
  • Make recommendations to define and improve quality of processes.
  • Monitor assigned facility data reports.
  • Research all denials with a forensic record review in a timely manner with a follow-up plan of correction. Then implement the plan of correction with the corresponding facility heads, providers and payors for an expedient resolution.
  • Assist with on-going education for treatment team providers regarding their role in maintaining documentation standards for all clients.
  • Interface with managed care organizations, external reviews and other payors.
  • Other duties as assigned and appropriate.
Qualifications:
  • High School/GED required; Associate degree preferred
  • Utilization Review experience required
  • Proven managerial skills with 2-3 years in a supervisory role
  • History of effective and proven leadership skills combined within a team environment
  • HIPAA Certification required upon employment
  • Ability to maintain confidentiality in compliance with HIPPA Guidelines
  • Understanding of medical terminology, diagnostic terms, and treatment modalities.
  • Working knowledge of Windows-based applications, including Outlook, Word and Excel
  • Strong and professional communication skills
  • Skilled in negotiation and problem-solving aptitude
  • Strong interpersonal organizational, evaluative and time management skills. Patience and ability to manage stress and maintain confidentiality
  • Strong written and verbal communication skills
  • Self-starter, self-sufficient, self-confident leading to an ability to create a system for medical records and communication with Embark families in multiple programs
  • Working knowledge of Windows-based applications, including Outlook, Word and Excel.
Benefits:
  • Enjoy a comprehensive Benefits Program, encompassing medical insurance with a generous company contribution towards a high deductible plan, dental insurance, vision insurance, voluntary life and AD&D insurance, long-term disability, 401K with company matching, and paid maternal leave.
  • Revel in the balance of Company Paid Holidays and a PTO accrual schedule.
  • At Embark, we and our team members embody core values of empathy, trusting relationships, service, growth, and results. Join us in making a meaningful difference.

Embark is an Equal Employment Opportunity Employer. Embark is committed to enriching the therapeutic and healing experience it offers through the diversity of its employees and community. Embark seeks to recruit and support a broadly diverse staff who will contribute to the organization's excellence, diversity of viewpoints and experiences, and relevance in a global society.

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