What are the responsibilities and job description for the Utilization Review Specialist position at ADDICTION AND MENTAL HEALTH SERVICES, LLC?
THIS IS A REMOTE PRN (AS NEEDED) POSITION
Position Title: Utilization Review Specialist
Department: Administration
Reports To: Director, Utilization Review
Supervises: NA
Entry Level Qualifications:
Health care degree‑Bachelors preferred. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in office equipment i.e. typewriter, calculator, computer, copy machine and fax machine.
1. Must be able to see at 20/40 corrected in each eye and hear (hearing aid acceptable.)
2. Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift.
3. Must be able to walk within the facility a total of approximately two (2) hrs. per day.
4. Must be emotionally and physically capable of functioning under stressful situations.
5. If recovering, two years of continuous verifiable abstinence.
General Responsibilities:
Complete coordination of the facility's insurance certification including precertification and continued stay reviews, as well as follow‑up on all insurance denials, appeals and reconsiderations.
Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records”, and 45 CFR “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and patient health information.
Essential Functions:
- Maintain an "admission log" which records every admission to the facility with financial classification and U.R. information.
- Perform all pre‑admission certification reviews as well as continued stay reviews and provide information to the appropriate review agency or insurance company.
- Maintain a "call‑back' calendar for continued stay reviews and maintain a U.R. file for each patient.
- Review and maintain any correspondence pertaining to certification, appeals, denials or reconsiderations.
- Complete all Quality Improvement indicators for Utilization Management.
- Educating Counseling staff regarding documentation of patient care; and educating Crisis staff regarding intake assessments.
- Must maintain a professional demeanor and appearance, must not appear impaired or disoriented, but rather must present coherent and articulate speech, kept appearance, alert, oriented, and responsive to patients' needs and concerns.
- Regular attendance.
- Any other duties as assigned by supervisor.
