What are the responsibilities and job description for the Utilization Reviewer position at PINELAND BH/DD CSB?
This position is to work at Pineland Administrative Office in the Utilization Management Division.
An utilization reviewer:
· Serves as clinical resource in Behavioral Health/Addictive Disease to ensure compliance with regulations, standards and policies (e.g. admission criteria, clinical exclusions, billing and documentation requirements)
· Reviews clinical documentation (e.g. assessment, progress note, treatment plan) for required External Review Organization (ERO) and agency standards
· Provides support, feedback and monitoring related to the completion and submission of clinical/programmatic requests for service authorization for ASO and Care Management Organizations (CMO’s) and assists clinicians 1:1 as needed to correct isolated problems
· Analyzes reports to monitor authorizations, failed claims/activities and program discharges, as assigned
· Reviews failed authorization reports to identify trends and troubleshoot errors with ASO and CMO’s. Monitors unresolved errors and notifies clinical and billing staff immediately of needed correction and resubmission.
· Conducts internal audits to include Peer and Quality Reviews to ensure Programmatic Integrity based on ERO and agency standards
· Assists with ERO audits and reviews, as assigned
· Collaborates with UM and Pineland programs in the development and monitoring of corrective action plans, as assigned
· Provides scheduled trainings on documentation, service utilization and standards and introduction to EHR system for new employee orientation. Monitors clinical support requests for trends/training needs and collaborates with UM to develop trainings and/or materials for staff. Program specific trainings are provided, as assigned.
· Attends agency and statewide meetings as determined by supervisor
· Maintains a good working relationship with physicians/clinicians/admin support/business office and others to keep them informed about new rules and regulations
· Completes accurate UM data entry from forms, records, and/or reports using a computer
· Acts as back-up to UM for ASO batch process and reporting, as needed
· Performs daily tasks with minimal supervision
Bachelor's Degree Science or Art required. Candidates must have a Ga Driver's License without suspensions in the past 5 years.
Pineland is and EEO agency.
Job Type: Full-time
Pay: From $32,739.41 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- Monday to Friday
Work Location: In person
Salary : $32,739
