A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
Responsibilities Utilization Review (UR) / Utilization Management (UM) Coordinator (Licensed Therapist or RN) The Utilization Review / Utilization Management Coordinator works closely with the other staff of Utilization Review/Management, Intake, Business Office, Medical Records, Clinical Staff, Nursing, and providers to coordinate and communicate patient information to insurance companies for the assignment of benefits. Performs clinical reviews over the telephone and electronically. Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases. Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance.
Apply online at https:
//jobs.uhsinc.com/turning-point-care-center I nterested in relocating to our community? Learn more about the city of Moultrie and Colquitt County here: https://moultriechamber.com ; https://colquittcountyga.gov ; https://moultriega.com. Centrally located in South Georgia, our facility is 30 minutes from
I-75, 1.5
hours north of Tallahassee, FL, 3 hours south of Atlanta, GA, and 2.5 hours west of Jacksonville, FL. Our employees reside in Moultrie or surrounding communities including Albany, Tifton, Thomasville, and Valdosta, GA. Join our team and discover a rewarding, fulfilling career. Turning Point Care Center, LLC For more than 40 years, Turning Point Care Center has provided a place of healing and hope to adults who suffer from behavioral health disorders and/or substance abuse. We are committed to providing quality behavioral health care through our inpatient and outpatient gender specific programs in Moultrie, GA. Our serene, rural setting gives patients a secure environment where they can build their foundation for lifelong recovery. We believe in creating healthy communities, which start with healthy individuals, linked through sound relationships to their families, friends, neighbors and peers. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.
Visit our website at https:
//turningpointcare.com to learn more. We offer a competitive and comprehensive benefits program including: Medical Dental Vision Life Insurance Flexible Spending Accounts Health Savings Accounts Short and Long Term Disability 401K with match Employee Stock Purchase Plan and additional voluntary benefits and discounts. (Even Pet Insurance!!) Additional benefit details provided at https://benefits.uhsguest.com . Choose "I am a Guest" to view options designed to enhance and promote our employees' health and wellbeing. Qualifications Licensure through state composite board for nursing or counseling/therapy: Minimum
RN, LMSW, LAPC, LAMFT
Preferred
BSN, MSN, LCSW, LPC, LMFT
Three (3) years of experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness Knowledge and understanding of a variety of insurances including: Traditional Medicare, Medicare Advantage Plans, and Commercial Plans Knowledge and experience with chemical dependency programs, mental health programs, situational evaluations, and crisis intervention, preferred.
