Utilization Review Assistant - Hybrid Position (In State)

Company: Santa Fe Recovery Center
Location: Santa Fe
Posted on: May 26, 2023

Job Description:

Description:Santa Fe Recovery Center (SFRC) is searching for the right candidate who believes that everyone deserves access to quality, evidence-based substance use treatment and that recovery is possible. The candidate should have a clear vision of why they want to work for us are wanting to grow and learn, and have a desire to serve diverse populations and underserved communities.Under the direct supervision of the Deputy Clinical Director, 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 Utilization Review Assistant will work to ensure that ASAM dimensional criteria are 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 Utilization Review 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.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.PM21PI217595411

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