Ventura Cannabis and Wellness Corp CVHIF

Utilization Review Coordinator - recent job posting

[maple68]

Utilization Review Coordinator
Health Services40 reviews - Los Angeles, CA

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