Utilization Review Specialist (remote)

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Utilization Review Specialist/Behavioral Health Substance Abuse

FLSA Status: ExemptClassification: Full-Time Reports To: The UR Specialist will report to UR Manager. Job Overview:The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides 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 will perform appeal reviews as needed.Responsibilities and Duties:

Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive manner in the professional Participate in staff meetings as needed
Clear communication with supervisors, co-workers, and facilities
Keeps abreast of changes to, and monitors compliance with, State and Federal laws and regulations in areas of insurance/ third party payers
Protects the confidentiality of patients and the privacy of staff
Uses a computer to type correspondence, reports and other items as requested, ensuring that typing is accurate
Process data in conjunction with compliance consultant in order to present it effectively using established statistical methods
Demonstrates the willingness to accept responsibility
Performs other duties as assigned by the Director of Utilization Review

Skills and Competencies:

Prior Utilization Review experience in a Substance abuse environment is mandatory.
Knowledge of ASAM guidelines.
Ability to establish rapport with and supervise employees as well as professional staff and peers
Ability to work under stressful conditions and is flexible in relation to department needs.
Knowledge of medical terminology.
Demonstrates proficiency in Verbal & Written Communication
Skills.
Knowledge of State & Federal Statutes Regarding Patient Confidentiality Laws.
Knowledge of Drug-Free Workplace Policies. Knowledge of Corporate Integrity & Compliance Program.
Knowledge of state guidelines and accreditation agency standards
KIPU experience required, Best Notes experience a plus

Requirements/Qualifications: Some positions may require a certain level of education, related work experience, knowledge, skills, abilities, licensures, certification and/or other job related requirements.

Prior Utilization Review experience in a Substance abuse environment is mandatory.
BA in Psy. min. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, Case Manager, or Utilization Review Coordinator).

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. 60000.00 To 63000.00 (USD) Annually

This job is no longer open

Life at Coronis Health

Coronis Health is a group of revenue cycle companies strategically brought together each with their own unique specialty expertise and experience. We started with the idea that no multi-specialty RCM company is an expert in every specialty. It became Coronis Health's mission to seek out companies with deep experience and success in a specific specialty to join the Coronis family. The result â€“ a new kind of RCM company with teams of experts in over 16 specialties. Coronis Health is built on the foundation of pure performance, transparency and specialization. With over 30 years of experience in healthcare RCM, we've seen it all. We understand the stress and challenges that come with managing your billing and collections process. Most importantly the time it takes away from the reason you became a doctor. Because Coronis takes on the administrative and staffing burden of managing your revenue cycle in house, our clients often see an increase in collections and a decrease in the amount of time it takes to get paid.

Thrive Here & What We Value- Inclusive Environment- Celebrate Diversity- Emphasis on patient confidentiality and maintaining accurate billing records- Encourages teamwork and collaboration among employees- Provides opportunities for professional growth and development- Commitment to Celebrating Diversity- Equal Opportunity Employer- Competitive rates tailored to your geography and expertise- Positive attitude, desire to mentor and willingness to help others- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</s>

Utilization Review Specialist (remote)

Life at Coronis Health

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