Substance Abuse Utilization Review Specialist
Job Title: Utilization Review Specialist
Reports to: Director of Utilization Review Department
Department: Clinical
Salary: DOE
Benefits (after successful completion of introductory period)
Summary:
The Utilization Review Specialist performs live utilization reviews of behavioral health and substance abuse intensive treatment services with insurance companies. Assess individuals' current or proposed treatment plan to identify and address potential barriers to discharge and assist in transitioning care to a lower intensity service setting.
Job Duties:
Perform live utilization reviews of mental health and substance abuse intensive treatment services with insurance companies.
Assess individuals' current or proposed treatment plan to identify and address potential barriers to discharge and assist in transitioning care to a lower intensity service setting.
Monitor the quality of care, and the member's response to services and products delivered to determine if the goals of the plan of care are being achieved, whether those goals remain appropriate and realistic, and what actions may be implemented to enhance positive outcomes and promote optimal health.
Maintains an ICM caseload of high-risk members utilizes the electronic case management system and provides proactive case management services.
Maintains tracking logs for inpatient status, determinations, and appeals.
Performs accurate data entry of all clinical information and authorizations.
Manages stressful situations calmly and rationally and identifies potential high-risk situations involving consumers through utilization review.
Demonstrates an ability to effectively communicate utilization decisions to healthcare professions and develop collaborative treatment plans.
Attend weekly Clinical meetings
Requirements:
One year of experience in a human services setting; strong professional references attesting to high degree of customer service, punctuality, and professionalism.
One year experience in performing UR's
Clean DMV record and/or in accordance with company insurance requirements.
Valid California Driver's License.
Ability to follow instructions clearly and precisely while experiencing multiple competing demands for employee time Current certification in First Aid/CPR
CAADAC/CAADE
Current certification or licensure (CADC, MFT, LCSW)
Current certification in First Aid/CPR
The job duties listed above should not be construed as an exhaustive list of all job duties required. Other duties will be assigned as need arises and according to programmatic need. Estimated Salary: $20 to $28 per hour based on qualifications.
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