What are the responsibilities and job description for the Utilization Review Specialist position at Hickory Recovery?
Utilization Review Specialist - Hickory Recovery Network
Department: Utilization Review
Direct Report To: UR Supervisor
Job Type: Full-Time
About the Role:
- Under the immediate supervision of the Utilization Review Supervisor, the UR Specialist is responsible for the facilitation of clinical pertinence reviews for all client admissions and continued stay requests to obtain authorization from insurance providers for treatment.
- The UR Specialist is an integral member of the corporate UR team, responsible for serving as the liaison between Hickory Network and all payer sources to ensure treatment is funded appropriately.
Why Hickory Recovery?
Hickory Recovery is setting the benchmark in mental health care, especially for those facing acute challenges or dealing with co-occurring disorders. Our focus is on
- Delivering personalized, top tier care that fosters healing and improves wellbeing
- Ensuring every individual has access to the best possible support and treatment
Our Mission is to provide high quality, acute care to adults struggling with mental health issues or mental health co-occurring disorders. It’s Hickory’s primary goal to offer expert treatment for all we serve.
What We Offer:
- 401k
- Dental insurance
- Flexible schedule
- Health insurance
- PTO
- Vision insurance
- Career development
- Mental health days
- Holiday pay
Job Qualifications:
- Associate degree in nursing (LPN or RN), bachelor’s or master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
- Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
- Understanding of Substance Use Disorders and Dual Diagnosis
- Must maintain a positive demeanor and clear understanding of professional boundaries with clients and staff.
- Ability to follow directives explicitly, adhere to facility policies, and exercise time management skills.
- Schedule flexibility may be required to accommodate clients.
- Must hold a valid driver’s license with reliable transportation.
Key Responsibilities:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
- Monitors HIPAA compliance
- Complete all required reports in a timely and accurate manner.
