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.
Clinical Utilization Review Specialist South Carolina Youth Advocate Program - 3.9 Columbia, SC Job Details Part-time 1 hour ago Qualifications Addiction counseling Management Accreditation standards (regulatory compliance area) Child welfare services experience Group therapy Clinical case management Mental health counseling Working with individuals with mental health conditions Medicaid regulations Medicaid Individual counseling Full Job Description
CLINICIAL UTILIZATION REVIEW SPECIALIST
(PART-TIME
UP TO APPX. 25 HOURS/WEEK / HYBRID - OFFICE/REMOTE
)
UTILIZATION REVIEW DEPARTMENT - COLUMBIA, SC REPORTS TO DIRECTOR OF MANAGED CARE/ SR. DIRECTOR OF BILLING, MANAGED CARE, AND GOVERNMENTAL RELATIONS
Part-time position available; reports to the Director of Managed Care / Sr. Director of Billing, Managed Care, and Governmental Relations in the Columbia, SC office. SCYAP is seeking an energetic, self-motivated individual to work with children with special needs and their families in Richland County for the following positions: SCYAP is seeking a Clinical Utilization Review Specialist to assist with initial/continued stay prior authorizations and reauthorizations on referrals for Rehabilitative Behavioral Health Services (RBHS). Primary responsibilities include, but may not be limited to providing interactive communications with billing department, regional Therapeutic Foster Care staff, quality assurance department, and referring agency personnel on status of referrals, and prior/continued stay authorizations; liaising with utilization management departments of insurance and managed care organizations to ensure authorization requests are reviewed and received timely in accordance with standards and expectations by Department of Health and Human Services and each managed care organization; maintaining a tracking system for prior authorizations/reauthorizations for RBHS; developing and maintaining a tracking system for completing timely treatment plans and reviews, and other appropriate documentation. Minimum of a Master's Degree from an accredited school with a minimum of one (1) year of experience in the area of child welfare of mental health. Licensure in the healing arts (LPC, LISW-CP, LMSW, LMFT, Ph.D., M.D., etc.) preferred. Knowledge of and/or ability to learn contractual standards, Medicaid standards, accreditation standards, and program specific policies and procedures required. Must possess strong organizational, process, and people management skills. Salary/benefits; pay dependent on experience and education. For consideration, please e-mail resume: South Carolina Youth Advocate Program 140 Stoneridge Drive, Suite 350, Columbia, SC 29210
Attn:
Human Resources Department/ALR Please indicate position in subject line. No phone calls please. Position will be posted until filled.
License/Certification:
LPC, LISWCP, LMSW, LMFT, Ph.D., M.D., etc. (Required) Ability to
