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Utilization Review Specialist
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Stepworks Recovery Centers LLC
Remote
Full-Time
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Job Description
Stepworks is a thriving company and trusted addiction treatment provider with facilities throughout Kentucky. We walk with patients during the early steps of recovery and provide resources to support their long-term sobriety. Our mission is to help people hurt by addiction reclaim their dignity and build a better life. Stepworks gives team members continuing opportunities to learn, grow, and inspire in a valued sector of the healthcare industry. Read more of our story at stepworks.com/careers.
POSITION
Utilization Review SpecialistLOCATION
Elizabethtown, KY- Remote (- Must be a KY resident)
QUALIFICATIONS
- high school diploma
- experience with behavioral health pre-authorizations
- familiarity with medical terminology
- proficiency with electronic medical records
- excellent computer and online skills
- excellent customer service and telephone communication skills
- excellent people skills: can create good relationships with other team members, patients, and insurance representatives
- organizational skills: ability to multitask, make decisions, work independently, manage time, meet deadlines, and excel in a fast-paced setting
- minimum of one year of utilization review experience
RESPONSIBILITIES AND TRAINING
- identify the level-of-care for patients based on ASAM criteria
- understand substance abuse treatment (assessments, treatment planning, continuing care recommendations, medication)
- understand the managed-care system (ASAM criteria, behavioral health insurance benefits and pre-authorization, utilization review, peer reviews, discharge reviews)
- provide verbal and written documentation required by insurance providers
- provide the documentation for utilization reviews, discharge reviews, and peer reviews
- prepare, submit, and follow up on appeals
- maintain electronic medical records
- regularly communicate with appropriate Stepworks team members to insure all steps are taken to obtain authorizations
SHIFT:
Monday-Friday, 7:00 A. M. to 3:00 P.M. BENEFITS
- health, dental, and vision insurance
- life insurance, short-term disability, hospitalization, and critical illness policies
- 401K with employer matching after one year of employment
- paid time off