Utilization Review Specialist - Behavioral Health

Overview

 

 

Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, and mental health issues.  We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns.

 

At Advanced Recovery Systems, we are committed to the journey of long-term recovery for our patients. As a Utilization Review Specialist, you play a critical role in this mission by serving as the vital link between our healthcare services and insurance payors. Your expertise in reviewing medical documentation, advocating for necessary treatment, and coordinating with insurance companies ensures that our patients receive the appropriate duration and level of care. This position is not just about phone calls and paperwork; it’s about enabling life-changing treatment for those in need by making sure it’s financially accessible and justified. Join us in making a tangible difference in the lives of our patients and their families. Your role is not just important; it’s integral to the healing process.

 

What we offer:

• Starting pay $50,000/yr, based on experience.
• Free Teladoc access and visits to employee and eligible dependents! 
• Benefits begin on the 1st day of the month following date of hire.
• Matching HSA - up to $1500/yr contribution from the company to your HSA.
• 401(k), medical, dental, vision, and generous vacation time!
• Employee Referral Bonus - you can earn up to $4000.

 

Take the first step toward making a difference and saving lives.

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Pay Maximum

Responsibilities

The Utilization Review Specialist (UR Specialist) is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews throughout the duration of patient’s treatment stay, and assists the treatment team in understanding the different requirements that various insurance companies have for admission, continued stay and discharge planning.

 

Core Job Duties:

• Completes pre-authorizations/concurrent reviews/internal UR reviews
• Consults with various members of the multidisciplinary treatment team concerning required information to complete concurrent reviews
• Schedules peer to peer reviews and coordinates urgent/expedited appeals
• Staffs individual cases with MDs as needed
• Follows all standard ARS Utilization Review Department policies and procedures.
• Utilizes the UR Census Report on a daily basis.
• Makes all initial calls within 24 hours, and follow up calls every 24 hours.

Other Required Tasks:

• Data entry, records management and assisting with the appeals process.
• Completing detailed daily documentation.
• Works with Finance Department regarding client service authorizations.
• Communicating frequently with the treatment team.
• Other duties as assigned.

 

Position Competencies:

• Proficiency in establishing and maintaining positive and effective communication with managed care companies.
• Ability to aligns medical and counseling staff to ensure services are provided at the appropriate level of care in a timely manner consistent with the patient’s condition and in compliance with governmental and accrediting agencies.
• Concurrent Reviews
• Utilization Review
• Census Report
• ASAM criteria Ability to be resourceful and proactive in dealing with issues that may arise.
• Demonstrate the ability to organize, multitask, prioritize and work under pressure.
• Effective time management

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Qualifications

• Bachelor’s degree in a health or behavioral health related field required, Graduate degree in a health or behavioral health related field preferred,OR
• High School diploma or equivalent and a State license (e.g., Registered Nurse, Licensed Practical Nurse, LCSW, LMHC) preferred.
• Minimum of three years’ experience working in a psychiatric or chemical dependency setting.
• Minimum of three years’ Utilization Review experience preferred.
• State licensure preferred (Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor).

 

We offer great benefits including 401(k), paid time off plan, medical, dental, vision, and much more.

 

Advanced Recovery Systems, a national integrated behavior healthcare management company dedicated to the treatment of add