Job:

PURPOSE STATEMENT

The Utilization Assistant provides support to all utilization review/management activities of the facility to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for clients. Assists in utilization reviews and insurance appeals. Responds to inquiries from clients, their families, and professional referral sources.

Roles and Responsibilities:

ESSENTIAL FUNCTIONS

Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations. Reviews medical records of clients for appropriateness of level of care at admission and at intervals determined by documentation in medical record. Conducts interactive and timely reviews with payers to ensure certification of care. Maintains accurate documentation and files as it relates to utilization management. Coordinates information and findings with the business office to help recognize or resolve possible payment problems. Attends daily treatment team to discuss client needs and ensure that all disciplines are aware of client insurance status and needs. Ensure that insurance benefits are verified in a timely manner. Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems. Responds to telephone and Internet inquires. Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

High School Diploma Required, Bachelor's Degree in social work, alcohol and drug addictions counselor, or other related health field preferred. One or more years of direct clinical experience in substance abuse setting and ASAM experience preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS

Not applicable.

SUPERVISORY REQUIREMENTS

This position is an Individual Contributor. Why Wooded Glen Recovery Center?

Wooded Glen Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Wooded Glen Recovery Center is an EOE. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. 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