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The UR Specialist coordinates payor benefits and length of stay approvals for client in our in and out-patient programs. The incumbent will monitor, coordinate, and provide necessary verbal and written documentation as required by the payor. UR specialist must understand all aspects of the managed care system, including requirements and protocols: ASAM criteria, verification and understanding of behavioral health benefits, precertification, utilization review, peer reviews, discharge reviews, appeals, and the claims process. Understand of substance abuse field and treatment process: assessments, treatment planning, continuing care recommendations, DSM- IV and medications.
Essential Job Functions:
- Complete all assessments and precertification’s for clients within 24 hours of admission, attempt made within 2 hours of admission.
- Complete utilization reviews, discharge reviews, and peer reviews as scheduled by or according to payor requirements. Hold payors accountable for their own UR policies and procedures.
- Initiate and follow up with all clinical appeals also prepares and submits medical records for appeals.
- Keep electronic record up to date with client authorization information, status and numbers for current and past clients. Submit data report weekly or upon request of supervisor or Convalo management team.
- Coordinate and facilitate weekly authorization meetings with each facility. Communicate coverage concerns effectively and immediately. Provide verbal status on authorizations, missing documentation and needed clinical information to obtain authorizations. Follow up with emails to ensure request are complete, hold facility and department accountable for gathering needed information within expected timeframe.
- Identify level of care placement for clients based on ASAM – 6 dimension criteria.
- Maintain good standing relationships with team and insurance companies.
- Perform all other tasks and assignments that may be required based on job summary
Qualifications:
- The ideal but not required candidate for this position is a licensed LMFT, LCSW, RN, LVN, and/or LPT, and billing experience is preferred. He or she must be proficient in Microsoft Office, have strong organization skills, and be able to make decisions and work independently.
- Knowledge of facility systems and organization as they pertain to medical records and organization review.
- Knowledge of medical terminology and medical record format and content required.
- Knowledge of recovery and an understanding of substance abuse.
- Excellent computer, internet, and business software skills
- Excellent customer-facing and phone skills
- Communication and interpersonal skills to develop relationships with clients, staff, providers and payors.
- Strong organization skills with a proven ability to multi-task and manage time to meet frequently changing deadlines in a fas t-paced environment
Experience: A minimum of one (1) year direct clinical experience in a substance abuse or mental health treatment setting. Experience in patient assessment, clinical and medical necessity appeals, treatment/discharge planning and communication with external review organizations or comparable entities.
Job Type: Full-time
Job Type: Full-time
https://www.indeed.com/cmp/Health-Services/jobs/Utilization-Review-Coordinator-fcb879e13b70ce9f?q=Convalo+Health
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Jr Project Manager
Health Services39 reviews - Los Angeles, CA
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The Jr. Project Manager is accountable for the day to day problem solving and daily monitoring development and of projects to help centralize processes for a drug and alcohol detox, intensive outpatient, and internal lab centers that optimize behavioral healthcare to adult clients.
Areas of responsibility include:
- Work with corporate to create and implement projects for drug and alcohol detox, intensive outpatient and internal lab centers to ensure on time delivery.
- Uphold systems by properly implementing and managing all staff until completion.
- Provides regular reports to assess and improve efficiency in all aspects of operations and communications.
- Manages any contractors to ensure that all services are correctly documented.
- Works closely with Corporate and Piers to ensure that each project delivers the best value based on historical unit cost for the company.
- Maintains policies and procedures that reflect current standards of practice and best practices consistent with industry standards
- Coordinates with Corporage to promote a culture of service to other Convalo Staffers
Required Skills & Qualifications
Minimum Qualifications:
- Strong organizational and analytical skills
- Ability to multi-task with effective time management
- Working knowledge of computer and software applications used in job functions
- Comfortable interfacing with personnel who have a wide range of skill sets, objectives and personalities working in clinical, marketing, financial and administrative aspects of company
- Ability to listen well, communicate effectively and forge consensus across different departments and geographic locations
Education and/or Experience:
- Bachelor Degree
- Minimum of two (2) years of project management experience, healthcare market experience not necessary
- Experience implementing or improving systems and software solutions as aeeded
- Develop quick creative solutions to difficult situations
Job Type: Full-time
Required education:
Required experience:
- project management: 2 years
https://www.indeed.com/cmp/Health-Services/jobs/Junior-Project-Manager-494baf3689d4306e?q=Convalo+Health
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