Utilization Review Specialist

We are looking for a Remote Utilization Review Specialist

Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, eating disorders and mental health issues. We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns. With facilities in various regions of the U.S., we have been furthering this mission since our inception, applying our advanced approach to patient care.

Every facility in the Advanced Recovery Systems network strives to provide the highest quality of care, using evidence-based therapeutic models that really work. Our goal is to help men, women and adolescents live healthy, happy lives without the burden of substance abuse or mental illness.

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
• 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

Requirements

• 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)

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

Advanced Recovery Systems, a national integrated behavior healthcare management company dedicated to the treatment of addiction, substance abuse, eating disorders and mental health issues. We invite you to learn more about us at our website!

The Company complies with state and federal nondiscrimination laws and policies that prohibit discrimination based on age, color, disability, national origin, race, religion, or sex. It is unlawful to retaliate against individuals or groups based on the basis of their participation in a complaint of discrimination or on the basis of their opposition to discriminatory practices/EEO

We are proud to be a drug-free workplace.

Benefits

What we offer

• Starting pay $50,000/yr, based on experience.
• Paid Time Off: Up to 2 weeks of paid time off per year plus sick pay & holiday pay
• 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 free Telehealth access
• Employee Referral Bonus - you can earn up to $4000

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