Manager Utilization Review

Job Description

Salary:

Company: Wise Path Recovery Centers

Location: Remote (must be in Eastern or Central time zone)

Ascension Recovery Services is searching for a Manager Utilization Review with SUD or behavioral health experience to join our team.

The Manager Utilization Review will be a hands-on manager and will lead the UR process, including developing policies and procedures, liaison with our 3rd party billing company and serve as the first point of escalation for payors requiring assistance in gaining additional or missing information to support authorization. This position will be responsible for ensuring procurement of authorization upon admission and discharge as well as accuracy of authorization information. The Manager will ensure timely escalation of barriers to authorization requiring clinical expertise and assist in coordination of Peer-to-Peer discussions with the payor.

Accountabilities

Performs and documents initial certification and continued stay reviews in appropriate time frame and appropriate database; Submits clinical reviews to payors, provides information to payors supporting admission /continued stay, manages requests submitted from payors, provides discharge dates to payors, submits copies of UM activities to payors, as needed

Obtains information from patients, caregivers, providers of services, insurance company, benefits administrators and others as necessary.

Conveys complete and accurate clinical information to payor throughout certification process; Obtains and enters authorization numbers from payors, Verifies up-to-date concurrent authorizations.

Research benefit data and options, programs and other forms of assistance that may be available to the client and negotiate for services as indicated.

Communicates pertinent reimbursement information to healthcare team while observing patient right to confidentiality.

Verifies in-network verses out-of-network benefits and communicates data to the patient and healthcare team as indicated.

Maintains follow-up communication with payor as required; confirms certification date with payor at time of discharge.

Documents obtained financial information in a complete, timely and concise manner.

Identifies trends in care, processes or services that may provide opportunities for improvement in a patient population, provider population or service unit.

Takes initiative to participate in a quality/process improvement initiative.

Identifies quality and risk management issues; refers issues for corrective action as appropriate.

Observes at all times legal and ethical considerations pertaining to client confidentiality.

Serves as a resource for other members of the healthcare team by participates in or conducts formal/informal in-service education as indicated

Promote and adhere to the workplace values of integrity, respect, trust, teamwork, quality, and excellence

Education, Experience, Skills

Bachelor's degree required, 3+ years of experience may be substituted for degree

Registered Nurse or Licensed Clinician preferred

3+ years of experience in utilization review, case management, or discharge planning

Experience in a Behavioral Health/SUD facility providing multiple levels of care required

Experience with commercial payors strongly preferred

remote work

Fully remote