Utilization Review Specialist

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Full Time WA, US

Salary Range: $55,000.00 To $65,000.00 Annually

The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

• Complete assessments and pre-certifications for clients.
• Communicate necessary information received to appropriate staffina timelyand efficient matter.
• Demonstrate understanding of medical terminology.
• Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
• Demonstrate knowledge of EOB interpretation.
• Daily use of ten key, dataentryand spreadsheets applications.
• Communicate effectively with peers andsupervisorto address billing and claim issues.
• Follow all HIPAA, compliance,privacy and confidentiality standards.
• Participate indevelopmentof Quality Improvement projects.
• Follow all practices detailed inthe companies
  
  Policies and Procedures Manual and Employee Handbook.
• Attend andparticipatein staff meetings andtrainings.
• Demonstrateexpertisein Psychiatric and Addiction Disorders.
• Engage inappropriate written and verbal communication with families, insurance companies and other professional.
• Demonstrateability to work with Excel,Wordand electronic chanting.
• Ability to work with minimal supervision.
• Organized and detail oriented.
• Other dutiesas assigned.

Knowledge:
The UR Coordinator will:

• Possessproficiencyin Excel,Wordand electronic charting.
• Demonstrateability to work with minimal supervision.
• Basic knowledge of HIPAA.
• Demonstrateability to work under pressure.

Abilities:
To excel in this position the incumbent should be able to demonstrate the following competencies:

• Problem Solving– The UR Coordinator will be able toidentifyand resolve problems in efficient and effective ways.
• Ethics – Treat clients, staff, co-workers, visitors, contractors, and guests of Sunshine Behavioral Health with respect and dignity; work ethically and uphold the values and standardsor
  
  Sunshine Behavioral Health.
• Attendance, Punctuality, Reliability – Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are coveredin the event ofan absence or scheduled vacation.
• Leadership – Constant development of staff,co-workers and clients, ineffortto achieveeach individual’shighest potential.
• Strong Character – Staying calm under pressure is essential. Having an approachable demeanor without compromising
  
  Sunshine Behavioral Health Standards of ethics and workmanship.
• Flexibility–Openness to different and new ways of doing things; willingness tomodifyone's preferred way of doing things.
• Organization – Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them.

• A minimum of twoyearof experience with Utilization Review.
• Valid Driver’s License.

Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind.