What are the responsibilities and job description for the Utilization Review (UR) position at Buffalo Valley Inc?
LOCATION: Hohenwald, TN
SCHEDULE: Mon - Fri, Day Shift
SALARY: D.O.E.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- Reviews pre-screening/initial assessment information to determine appropriateness for admission to treatment and at which level of care.
- Serves as a patient advocate to receive authorization for needed treatment days/services.
- Communicates clinical information to third party payers within specified time frames agreed upon in provider contracts.
- Acts as a liaison between the Primary Counselor and the third party payer.
- Communicates third party payer length of stay criteria, per individual patient, to the Primary Counselor, which assists the Counselor in determining the patient's individual treatment and discharge planning.
- Documents pertinent information to serve as a record for billing questions.
- Adheres to Tennessee Code of Ethics and Buffalo Valley policies and procedures.
- Completes admission process on new admissions as time permits.
- Serves on committees as assigned.
- Maintains specified Q.A. logs regarding unusual discharges, length-of-stays, etc., and provides reports in monthly leadership meetings.
QUALIFICATIONS
- Must possess clinical expertise in the assessment of alcoholism/chemical dependency, as well as a working knowledge in ASAM PPC-2.
- Able to work cooperatively with multi-disciplinary staff.
- Is knowledgeable if current up-to-date information regarding managed care organizations, Federal and State mandates, and communicates new information to appropriate departments.
- Valid TN D.L. with "F" endorsement required; "F" endorsement can be obtained once hired
- Individual must be able to perform each essential duty satisfactorily and in a timely manner.
- Up to date computer skills and learn new software such as TIER EHR (electronic health record) system, Excel, Office 365 and email.
- Ability to use phone, fax and other office related equipment.
- Pass Background Check and Drug Screen required
- Keeps a current CPR and First Aid certifications, required
EDUCATION and/or EXPERIENCE
- Higher Learning Degree preferred but not required
- Familiarity with 12 Step philosophy and terminology, along with a working knowledge of ASAM Patient Placement Criteria.
- High School Diploma or GED
BENEFITS AVAILABLE
- Health
- Vision
- Dental insurance
- Paid Vacation and Sick time
- 401K
- Life Insurance (Company Paid)
- Life Insurance (Voluntary purchase)
- Optional: AFLAC policies available through payroll deduction
Buffalo Valley is a Drug-Free Workplace and Equal Opportunity Employer. Buffalo Valley does not discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy, transgender status, and sexual orientation), national origin, age (40 or older), disability or genetic information.
