Utilization Review Coordinator
Utilization Review Coordinator
OVERVIEW: Utilization Review Coordinator will perform all functions of utilization review for IOP and OBOT programs with insurance companies. The coordinator functions as a clinical liaison between payers and the IOP and OBOT programs, providing information and feedback to assist in optimum patient care reimbursement.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Administer IOP and OBOT programs by ensuring timelines to ensure all provided care is authorized within contractual timelines
- Initiating Precertification for patients entering a Landmark IOP and OBOT program applying clinical knowledge
- Conducting Concurrent Reviews on patients being treated at a Landmark IOP and OBOT program and ensuring documentation meets insurance requirements for level of care
- Tracking patients across Landmark’s locations to ensure timely and accurate billing
- Implementing Quality Control to ensure cohesiveness across the IOP and OBOT program by communicating effectively with the treatment teams
COMPETENCIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Intellectual
- Excellent critical thinking skills
- Detail-orientated
Interpersonal
- Excellent verbal and written communication skills to interact with co-workers and third- party vendors.
- Team-orientated individual
Leadership
- Successfully coordinate across multiple parties both internally and externally.
Organization
- Able to track multiple claims simultaneously
- Keep a detail and accurate list of claims
- Provide an accurate and holistic view of a situation
Self-Management
- Motivated self-starter with drive to complete all tasks
- Completing all tasks assigned in a timely manner
- Able to stay on task with little supervision
Language, Math, and Reasoning
- Ability to articulate information to all parties involved.
- Excellent vocabulary
EDUCATION, EXPERIENCE, and TRAINING:
- Bachelor’s Degree in behavioral health or related field
- Novice understanding of ASAM criteria
- Knowledge of substance use disorders and co-occurring disorders
- Knowledge of common clinical interventions for SUD’s and co-occurring disorders
CERTIFICATES, LICENSES, REGISTRATIONS:
- None required.
COMPUTER SKILLS:
- Familiarity with SharePoint and Excel
- Proficient in Microsoft Office
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The employee must occasionally lift and /or move up to 25 pounds.
- While performing the duties of this job, the employee is regularly required to sit; talk; hear.
- While performing the duties of this job, the employee is frequently required to reach with hands and arms.
- While performing the duties of this job, the employee is occasionally required to stand; walk; use hands to finger, handle, or feel.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
- This position works in an environment with moderate noise level. (Examples: business office with computers and printers, light traffic.)
Job Type: Full-time
Pay: From $60,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Physical setting:
- Office
Schedule:
- Monday to Friday
Work Location: One location
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