JOB SUMMARY:

The Utilization Review specialist is responsible for managing an active caseload of clients for the following levels of care: Detox, Residential, Intensive Outpatient, and Behavioral Health. S/he acts as a liaison between the Billing Manager, the client, and the Clinical Team. Candidate with at least three (3) years of clinical experience with addiction treatment of adults experiencing substance use problems and disorders. The review specialist is primarily responsible for ensuring that every client at our addiction treatment centers and primary mental health has the appropriate precertification and concurrent reviews completed in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to this class.

• Adhere to Alter Management’s Policies and procedures.
• Assessing medical necessity for admission, reviewing appropriate levels of care.
• Perform initial evaluations of client needs and develop customized treatment plans.
• Complete precertification documentation upon client admission and retrospective reviews in a timely manner to ensure continuous coverage.
• Verification of VOB’s
• Verification of benefits
• Collaborate with clinicians in order to obtain necessary clinical documentation for reviews.
• Collaborate with admissions and management to determine appropriate length of stay and discharge dates.
• Reviewing all medical records before they are submitted.
• Updating spreadsheets for reporting and documentation purposes.
• ASAM (American Society of Addiction Medicine) charting standards.

MINIMUM QUALIFICATIONS:

EDUCATION/EXPERIENCE:

• Bachelors / Masters
• Undergrad in Psychology
• Minimum of 3 years experience in a related clinical setting. Managed Care and Utilization Management experience required.
• Behavioral Health Management experience with a concentration in substance abuse counseling required.

CERTIFICATES & LICENSES:

Has CPR and First Aid certifications.

KNOWLEDGE:

• An acute understanding of counseling and other treatment procedures for alcoholism and drug addiction related problems and primary mental health.
• A knowledge of regulations concerning alcoholism and drug addiction treatment and primary mental health.
• Working knowledge of alcoholism and drug addiction and treatment procedures for such illness.

The above job description is intended to describe the content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.