Location: Fully remote position. Headquartered in Bluffdale, UT. Targeting candidates in the Utah, Idaho, Louisiana, Georgia, Alabama.
Type: Full-Time, Salary, Exempt
Reports to: Utilization Review Manager

*** As this is a remote position, reliable internet connection is required.

The Company: We are the leader in substance abuse, mental health, and behavioral health billing and take great pride in the level of service we provide our clients and patients. We were named a Top 10 Emerging Medical Billing Company in the nation by Healthcare Business Review in 2021. The team is an impressive team of billers - we have really great teamwork, we’re incredibly devoted to customer service, and are very dedicated to doing things the right way. Come help us continue making a strong team and culture! The Company is in a very exciting phase as we are growing and adding new facilities to our clientele. We’re looking for at least one Utilization Review Specialist to add to our team to help assist with our growth and help continually improve our processes.

The Role: As a Utilization Review Specialist, you will be a key member of the Utilization Review Team as the face to our clients and the clients’ liaison to the insurance companies. You must strongly advocate for increasing patient care on behalf of the patients and our clients when working with insurance companies’ case managers. This role balances high attention to detail as well as high levels of persuasive communication and efficiency - success comes from mastering them. Our Utilization Review Team highly values persistence, collaboration and trustworthiness. And so do our clients.

Responsibilities:

• Successfully conduct pre-authorizations and utilization reviews of behavioral health, substance abuse and mental health cases – You will conduct numerous cases daily.
• Advocate with and for our clients’ patients with health insurers to obtain optimal authorization for treatment.
• Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc. in a professional manner.
• Perform utilization management, utilization review or concurrent reviews
• Identify ways to add value to treatment plans and consulting with facility staff or care providers
• Effectively train and influence facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
• Maximize number of days authorized for each patient for each level of care
• Timely notify each client of deadlines and dates for utilization reviews, peer-to-peer reviews, etc.
• Keep notes and statuses up to date and accurate within our electronic systems.
• Establish and maintain professional working relationships with clients, providers, and insurance companies - our clients need to absolutely love working with you.
• Facilitate clients’ training on our processes and procedures.
• Demonstrate and value adherence to policies pertaining to patient privacy, following all HIPAA requirements.
• Other responsibilities as assigned.

Qualifications:

• At least 2-3 years of utilization review and/or clinical experience in a behavioral health institution; emphasis in dual diagnosis with mental health and substance abuse preferred.
• Preferred Licenses include: LCSW, CMHC, MHT, or RN
• Must have superior customer service skills.
• DSM V Experience
• ASAM criteria comprehension
• Experience with pre-authorization and utilization reviews
• Effective oral and written communication skills with prompt and professional response.
• Experience with Microsoft Excel/Google Sheets required.
• Experience with ADS/Medics Premier is a plus.
• Proficiency with Best Notes, Kipu, Availity, and ChangeHealthcare preferred.
• Self-motivated with strong organizational skills and superior attention to detail.
• Experience with Google Workspace/G-Suite is a plus (Google Docs, Google’s folder system, etc.)
• Must be able to manage multiple tasks when given.
• Capable of working within and adapting to new policies, procedures and practices prescribed by the Company.

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• Paid time off

Medical specialties:

• Psychiatry

Physical setting:

• Acute care
• Inpatient
• Outpatient
• Rehabilitation center

Schedule:

• Monday to Friday

COVID-19 considerations:
Fully remote.

Education:

• High school or equivalent (Preferred)

Experience:

• Utilization review: 1 year (Required)

License/Certification:

• RN, LCSW, CMHC, MHT, or other similar certification? (Preferred)

Work Location: Remote

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