Utilization Review Specialist

5 days ago

Delray Beach, Florida, United States Coronis Health Full time $60,000 - $62,000 per year

Title: Utilization Review Specialist/Behavioral Health Substance Abuse
Reports to: UR Manager
FLSA Classification: Exempt
Full-Time or Part-Time: Full-Time
Salary Range: $60,000 to $62,000
Starting pay varies based on location and experience, in compliance with specific state wage regulations. Competitive rates tailored to your geography and expertise.

Position Overview:
The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The role involves providing appropriate client information to third-party payers regarding the medical necessity of treatment in a timely manner. The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews, and appeal reviews as needed.

Key Responsibilities:

  1. Act as the agency liaison with insurance and managed care companies for the authorization of treatment costs, representing the company in a positive and professional manner.
  2. Participate in staff meetings as needed.
  3. Ensure clear communication with supervisors, co-workers, and facilities.
  4. Keep abreast of changes and monitor compliance with State and Federal laws and regulations in areas of insurance and third-party payers.
  5. Protect the confidentiality of patients and the privacy of staff.
  6. Use a computer to type correspondence, reports, and other items as requested, ensuring accuracy.
  7. Process data in conjunction with a compliance consultant to present it effectively using established statistical methods.
  8. Demonstrate the willingness to accept responsibility.
  9. Perform other duties as assigned by the Director of Utilization Review.

Qualifications:

Minimum Education/Certifications/OTJ Experience:

  • BA in Psychology or a related field.
  • Three to five (5) years of experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, Case Manager, or Utilization Review Coordinator).

Knowledge of Subject Matter:

  • Prior Utilization Review experience in a Substance Abuse environment is mandatory.
  • Knowledge of ASAM guidelines.
  • Knowledge of medical terminology.
  • Knowledge of State and Federal Statutes regarding patient confidentiality laws.
  • Knowledge of Drug-Free Workplace Policies, Corporate Integrity, and Compliance Programs.
  • Knowledge of state guidelines and accreditation agency standards.

Skills:

  • Ability to establish rapport and supervise employees and professional staff.
  • Ability to work under stressful conditions and be flexible in relation to department needs.
  • Demonstrates proficiency in verbal and written communication skills.
  • KIPU experience required; Best Notes experience is a plus.

Abilities/Attributes:

  • Demonstrates willingness to accept responsibility and perform tasks with minimal supervision.

Additional Information:
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.
Coronis Health is committed to creating a diverse and inclusive environment where all employees are treated fairly and with respect. We are an equal-opportunity employer, providing equal opportunities to all applicants and employees regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected characteristic. We welcome and encourage applications from candidates of all backgrounds.

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