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Utilization Review Case Manager
4 months ago
Job Description
The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for our clients. The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight timeline.
Responsibilities
- Determine client medical necessity for insurance claims using various criteria and dimensions as dictated by the insurance carriers
- Work to build a case for medical necessity for potential clients
- Perform pre-intake assessments for potentially viable clients
- Work closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of care
- Conduct chart reviews to ensure clinical documentation matches level of care requested
- Ensure that authorization match the authorization obtained by you for the correct authorization number, the LOC , the facility, the number of days and the date range.
- Understanding DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all Levels of care.
- Communicate effectively, both written and verbal, with supervisor and all pertinent staff on your clients.
- File appeals for denied cases and follow through on that process
- Timely, organized documentation. Record keeping must be accurate and thorough.
- Demonstrate the ability to act as a team player in a professional and positive manner
This is a full-time position at our corporate office.
Qualifications:
Qualifications
- Preferred Master’s Degree minimum
- Preferred Licensed LMFT, LCSW, LVN, or RN
- Prior experience in doing utilization review for substance use facilities
- Strong knowledge of ASAM dimensions 1-6
- Knowledge of DSM-V Codes
- Knowledge of SUD,IOP, and Mental Health programs
- Flexibility with schedule to meet critical deadlines is essential.
Not sure if you meet all the qualifications? Apply anyway To provide truly innovative care, we need to have a diverse team around us. That’s why Discovery Behavioral Health is committed to creating an inclusive environment. If you find yourself meeting some but not all the above, we’d be happy to consider your application.
Additional Information
We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, or national origin.
For more information about our company benefits, please visit us at discoverybehavioralhealth.com/careers/
Discovery Behavioral Health seeks to build a diverse staff that is reflective of the patients we serve and the communities where we work. DBH encourages multiple perspectives, experiences, and strives to hire and retain a diverse workforce.
