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

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