Utilization Review Assistant-Hybrid Position (In State)

Company: Santa Fe Recovery Center
Location: Santa Fe
Posted on: May 21, 2023

Job Description:

Description:Under the direct supervision of the Utilization Review Specialist, the Utilization Review Assistant will work to ensure that all requirements of the prior authorization and concurrent review processes are completed in compliance with managed care guidelines and expectations. The UR Assistant will work to ensure that ASAM dimensional criteria is met in accordance with recommended levels of care and will work as part of a close, multidisciplinary team to ensure the best clinical outcomes are achieved. The UR Assistant will also work to coordinate aftercare and communicate case management needs to therapists and referral agencies. Under close supervision, the Utilization Review Assistant processes prior authorization and concurrent stay requests for Medicaid and private insurance for clients entering treatment and throughout the course of treatment at Santa Fe Recovery Center.WORK PERFORMED:

• Begins the insurance verification process for clients entering into subacute detoxification, or residential prior to client admission. If prior authorization is required, the UR Assistant will complete medical necessity reviews based on available clinical information.
• Works closely with direct supervisor, clinical team, financial team and billing specialists to ensure timely preauthorization and concurrent review processes are completed and documented appropriately.
• Works with clinicians and physicians to ensure clear diagnoses and treatment documentation required by MCO and insurers including clinical and medical necessity for treatment.
• Maintains a system to ensure timely re-authorization for clients in treatment in order to provide the continuum of care.
• Responsible for communication with MCO. Completes concurrent review forms when requested.
• Coordinates with MCOs to obtain authorization for services for both Detox, Residential and extended care levels of care at multiple treatment sites.
• Performs other related duties as required by the Utilization Review Specialist or Clinical Director.
• Attends all mandatory staff meetings.
• Maintains confidentiality in accordance with State and Federal law, the counseling code of ethics and SFRC policies and procedures.
• Understand and maintain HIPAA Standards relative to the SFRC.Requirements:
• A Bachelor's Degree (Master's degree preferred) from an accredited college or university in Nursing, Psychology, Social Work, Addiction Medicine or Alcohol/Drug Counselling.
• Current dependent license as: LBSW, LMSW, LMHC, LSAA, LAMFT, LPN or ability to be licensed within 9 months of hire.
• Current independent licensure: LPCC, LCSW, LADAC, LMFT or RN preferred.
• ASAM Certified preferred.
• Two years of experience working with clients with co-occurring mental health/substance abuse issues preferred.
• Two years of experience working in an inpatient setting such as a hospital, nursing facility, residential program, or jail/prison preferred.
• In the case of a recovering person, he/she must have successfully maintained a 3-year period of uninterrupted abstinence from alcohol and/or drugs.
• Must be computer literate in order to effectively maintain compliance with standards and requirements for use of computerized client assessments. Competitive Employee Benefits Package: The following benefits are offered to our full-time employees, their spouses, domestic partners, and dependent children:1. Medical2. 4% Matching 401(k) 3. Dental4. Vision5. Accident (Part-Time Eligible)6. Critical Illness (Part-Time Eligible)7. Employer-paid Disability8. Voluntary Life/AD&D9. Teladoc Virtual Visits (Part-Time Eligible)10. Pet Insurance In addition, the following benefits are extended to all full-time employees:1. Employer-paid Disability2. Employer-paid Basic Life/AD&DPM21PI216074179

Keywords: Santa Fe Recovery Center, Santa Fe , Utilization Review Assistant-Hybrid Position (In State), Other , Santa Fe, New Mexico