Utilization Review Specialist

Benefits:

Competitive salary

Please only apply if you live within 30 miles (roughly) radius of Malibu CA. Please only apply if you are currently seeking part-time employment. This position may turn into a full time position at a later date.

The UR staff is responsible for working directly with providers and facility staff to ensure coordinated, continuous coverage for current clients in treatment. UR specialists are tasked with advocating on the client’s behalf based upon medical necessity for appropriate care as needed.

Actively manages cases for applicable clients admitted through all levels of care in the substance abuse and mental health setting.

Works with the UR Director and facility contacts on case reviews for pre-service, concurrent, and retrospective authorizations and appeals, looking for medical necessity and appropriateness of service and care.

Generates approval, modification and denial communications, to include member and provider notification of referral or non-authorization determinations.

Acts as a department resource for medical records requests within the company.

Determines need for and may be trained to conduct in-service training to improve quality of admission and continued stay reviews, and to disseminate information concerning new or revised procedures.

Ensure the privacy and security of PHI (Protected Health Information) as outlined in the established policies and procedures relating to HIPAA compliance.

Possession of a valid driver's license

1-3 years of experience in UR setting is preferred but not required

Must have basic knowledge of medical terminology and behavioral health medications

Must be able to operate a general computer, fax, copier, and telephone

Must be knowledgeable of basic software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet

Exposure and familiarity with current EMR systems

Must possess proficient skills in English usage, grammar, and punctuation

Ability to follow instructions and respond to upper management directions accurately

Demonstrates thoroughness, looks for ways to improve and promote quality and monitors own work to ensure appropriate quality is met

Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed

Must be able to work independently, prioritize work duties, and use time efficiently

Must be able to maintain confidentiality & HIPAA

Must be able to demonstrate and promote a positive team-oriented environment

Demonstrates reliability and abides by the company attendance policy

Must maintain a professional and clean appearance at all times consistent with company standards

Pay:
Based upon experience.

This is a remote position.