Clinical Utilization Specialist

2 days ago


Arizona City, Arizona, United States Summit BHC Full time
Job Title: Clinical Utilization Specialist

Canyon Vista Recovery Center is seeking a skilled Clinical Utilization Specialist to join our team. As a key member of our healthcare team, you will be responsible for reviewing and managing the utilization of healthcare services to ensure that they are medically necessary and meet the standards of our facility.

Key Responsibilities:
  • Conduct thorough reviews of patient admissions, continued stays, and discharges to ensure medical necessity and compliance with facility policies and procedures.
  • Communicate effectively with insurance companies, healthcare providers, and other stakeholders to obtain authorizations and resolve any issues related to utilization management.
  • Develop and maintain accurate and comprehensive documentation of patient records, including medical necessity determinations and utilization review results.
  • Collaborate with healthcare providers and other team members to ensure that patients receive the necessary care and services to meet their medical needs.
  • Identify and address any issues related to medical necessity, including appeals and grievances.
Requirements:
  • Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field.
  • One or more years of direct clinical experience in a substance abuse setting and ASAM experience preferred.
Why Canyon Vista Recovery Center?

Canyon Vista Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Canyon Vista Recovery Center is an EOE. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.



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