Utilization Review Specialist

REM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You’ll join a mission-driven team and create relationships that motivate us all every day. Join us today, and experience a career well lived.

Salary: $ $40,170.00

Location:
Akron(Portage Lakes area)

Schedule:
Mon/Tue/Wed/Thur/Fri 8:30 AM - 5:00 PM

OUR MISSION AND PERFORMANCE EXPECTATIONS

The MENTOR Network is a mission-based organization dedicated to providing high quality services to those we serve. Therefore, to deliver on our mission, The Network expects every employee to perform his or her job first and foremost in accordance with the Company’s mission.

The Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective service utilization to customers. Provides professional oversight of service delivery authorizations and assurances, effective tracking and timely recommendations in regards to service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis.

ESSENTIAL JOB FUNCTIONS

To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:

• Develops plans to accurately measure documentation of services delivered to assure compliance with auditors
• Oversees service delivery authorizations and provides quality assurances of service delivery records

• Recommends service delivery utilization parameters
• Maintains knowledge of updated funding Rules and Contracts
• Notifies internal stakeholders for any updated information on service delivery, authorizations, and utilization of services
• Maintains organized and complete records and assures quality focused service delivery method strategies
• Monitors the regional office and storage filing systems
• Organizes records including availability for compliance audit file review
• Provides technical assistance to clinical staff in the service areas
• Facilitates timely and appropriate service authorization
• Monitors strategies
• Provides report analysis of actual service deliveries in comparison to authorized service approvals
• May direct and supervise clerical and administrative staff
• Provides feedback on performance evaluations
• Conducts scheduling, orientation, and training
• Resolves issues and serves as resource
• Performs other related duties and activities as required

SUPERVISORY RESPONSIBILITIES

May direct and supervise clerical and administrative staff, including performance evaluations, scheduling, orientation, and training. Provides feedback on employee performance and resolves issues within position responsibilities.

Minimum Knowledge and Skills required by the Job

The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:

Education and Experience:

• Bachelor’s degree required
• 1 year minimum work experience in human services required

Certificates, Licenses, and Registrations:

• None

Other

Skills and Abilities:

• For Ohio – Basic Excel skills and ability to learn the Ohio state billing software

Other Requirements:

• Travel as needed

Physical Requirements:

• Sedentary work.Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

AMERICANS WITH DISABILITIES STATEMENT

External and…