Utilization Review Counselor

Full-Time Opportunity Available

• Schedule: Monday - Friday

• Hours: 40-hour week

• Pay: $25.00 - $30.00/hr

Benefits Available for Full-Time Employees:

• Generous Paid Time Off Policy

• Medical, Dental, and Vision Insurance

• Flexible Spending Account

• Basic Group Life AD&D Insurance (No Cost)

• Voluntary Life Insurance

• Other Voluntary Benefits

• Reimbursement for Professional Development Expenses

• Employee Assistance Program

• Retirement Program (401k)

• 8 Paid Holidays

MAIN FUNCTION:

• Review appropriateness and clinical necessity of admissions, continued stays, and discharges

• Maintain contact for insurance approval reviews

• Assigned user role(s) and information systems access as needed

• Classified as Essential Day 2 for emergency closures

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Review patient EMR for admission, continued stay, and discharge criteria

• Perform telephone reviews with insurance companies/agencies and document in EMR

• Coordinate with departments (Medical, Nursing, Billing, etc.) for needed information

• Regularly update administration on UR Department status

• Obtain and review information for insurance appeal processes

• Ensure patient confidentiality and complete medical records for requested information

• Alert staff when additional documentation is needed and inform Medical Records

• Provide input at Clinical Exchange and Case Conference Meetings

• Inservice staff as needed

• Obtain precertifications for outpatient treatment and provide info to Outpatient Facilities

• Generate and distribute daily certification report

• Perform other duties as assigned

COMPETENCY REQUIREMENTS:

• Knowledge of Managed Care

• Clinical knowledge

• Strong communication skills

• EMR documentation proficiency

• Skilled in computer use, including EMR, Microsoft Outlook, and other systems

EDUCATION AND QUALIFICATIONS:

• Clinical experience in alcohol and substance abuse preferred

• Certifications: CASAC, CASAC-T, CCDN, CARN, LPN, RN

• Knowledge of medical records

• Ability to manage heavy telephone workload

• Strong communication and organizational skills

PHYSICAL DEMANDS:

• Must be able to talk and hear

• Requires close and distance vision, and focus adjustment

• Primarily sedentary, with occasional walking and standing

• Ability to use computer, keyboard, mouse, calculator, copier, fax, scanner, and telephone

Salary : $25 - $30