Job description

Job Summary:

The primary goal is to monitor adherence to the facility’s utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility admissions and extended facility stays.

JOB DUTIES:

• Completes Initial, concurrent, peer reviews, and expedited appeals in a timely manner to ensure continuous coverage.
• responsible for all aspects of the authorization of treatment via insurance and managed care companies.
• Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Collaborate with facilities in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.
• Represents the company in a positive manner per the Professional Standards of Conduct
• Protects the confidentiality of patients and the privacy of staff
• provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
• Uses a computer to type correspondence, reports and other items as requested,
• Experience in the Mental Health/Addiction space, May be a fully licensed SUDC, CAC,LADC, LCSW, CMHC or RN
• Additional duties as assigned.

MINIMUM QUALIFICATIONS

• Bachelor’s or Master’s degree in Behavioral/Mental Health Field (or related experience)
• A minimum of 3-5 years experience doing utilization review is required.
• Expertise in psychiatric and addiction disorders
• Experience interacting effectively with co-workers as well as clients.
• Experience maintaining confidentiality in accordance with HIPAA and company policy requirements.
• Proficient computer skills, including familiarity with common programs, such as Microsoft Office Suite.

PHYSICAL REQUIREMENTS

· Prolonged periods sitting at a desk and working on a computer.

· Must be able to lift up to 15 pounds at a time.

Job Type: Full-time

Pay: $55,000.00 - $80,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Medical specialties:

• Psychiatry

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Delray Beach, FL 33445: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Utilization review: 2 years (Required)

Work Location: One location

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