Wickenburg, Arizona
Utilization Review Counselor Job Opening in Wickenburg, Arizona - Position Scope and Summary:
The Utilization Review Counselor works with patient, financial office, physician and insurance companies to facilitate admission and continued stay in the facility. Utilizes knowledge of medical and psychiatric diagnoses, APA guidelines and DSM lV guidelines. Utilizes in depth knowledge of managed care process including pre-certification and con-current review. This position interacts with others as a professional and collaborative team member to insure that the center?s operating priorities are executed with precision and consistent excellence.
Minimum Qualifications:
Education ? Bachelor?s or Master?s degree in behavioral health discipline preferred.
Experience ? Minimum five to seven years? experience preferably in the for-profit healthcare sector. A basic working knowledge of DSM diagnosis, mental status examination and psychiatric medications. Eating disorder experience is preferred but will train the right candidate.
Skills ? Organizational skills; strong written and verbal skills; problem solving ability;effectively interface at all organization levels internally and externally; self-directed; commitment to professional standards, regulatory and personal development; and proficient computer skills.
Essential Responsibilities:
Performs ongoing job expectations in accordance with RiverMend Health?s scientific model strategies and operating guidelines.
Adds value daily in fulfillment of RiverMend Health?s vision to become the world?s preeminent leader in the treatment, research and education of alcohol and drug dependency, dual disorders, eating disorders, obesity and chronic pain.
Understands and lives RiverMend Health?s values ? Performance, Teamwork, Integrity, Trust, Leadership & Influence, and Innovation.
Adheres and complies with all RiverMend policies/standards whether internal, regulatory, legal, etc.
Maintains privacy of all company information and safeguards its confidentiality at all times.
Reviews patient documents for medical necessity.
Performs review with insurance company and provides written summaries as required by insurance companies.
Facilitates dissemination of information as required by insurance company, providers and staff.
Performs review/audit of facility documentation for accuracy.
Attends treatment-planning session for clients with current open cases.
Works in conjunction with business office to provide patient with financial information relating to admission.
Coordinates reviews with Medical Director as necessary.
Communicates information to financial office and staff.
Coordinates appeals process to insurance company for denials as well as written appeals.
Perform all UR for assigned location(s).
May perform Intake in back up capacity if required.
Achieves the key performance indicators that are required based on role specific responsibilities and business needs as referenced above.
Performs other duties as assigned.
RIVERMEND HEALTH MISSION:
Through the delivery of world-class, specialty behavioral health treatment, research and education, RiverMend Health seeks to enhance the quality of life of those who seek our help, their loved ones and the communities in which they live.
Job Type: Full-time
Required education:
Bachelor's
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