MUST HAVE UR EXPERIENCE IN SUBSTANCE USE AND MENTAL HEALTH DISORDERS.

JOB DUTIES AND RESPONSIBILITIES:

• Utilization Review Manager will oversee a team of in person and offshore UR Professionals and coordinate all communication with clinical and billing teams.


• Must be able to communicate substance abuse and mental health clinical information to insurance companies and payer services.


• Applicant must be familiar with admissions pre-certification process as well as concurrent and discharge reviews.


• Complete assessments and pre-certifications for clients utilizing insurance within 24 hours of admission seven days a week.


• Possess sufficient clinical knowledge to effectively communicate the acuity of a client’s condition and medical necessity of treatment with insurance reviewers.


• Provide effective communication and coordination with staff members regarding managed care decisions, to include obtaining timely and relevant information from therapists and staff about clients, informing relevant staff about managed care decisions.


• Conducts concurrent reviews with insurance companies and communicates pertinent information to the treatment team.


• Assists with initial reviews with the Admissions department as needed.

QUALIFICATIONS:

• UR experience calling insurance company for authorizations and concurrent reviews.


• Prefer candidates who have one of the following but not required: Certified Alcohol and Other Drugs of Addiction Counselor (CADC), Licensed Vocational Nurse (LVN) or Registered Nurse (RN), Doctor (MD, PhD., PsyD.), Therapist (LMFT, MFT, LPPC, LSCSW).


• Must have at least 5 years of experience working in the substance use or mental health disorders working in clinical, billing or UR capacity.


• Must have at least 3 years of experience managing in person and offshore teams.