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Utilization Review Specialist
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BasePoint Academy
Remote
$80,000 Salary, Full-Time
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Job Description
Utilization Review Specialist BasePoint Academy
- 3.8 Dallas-Fort Worth, TX Job Details Full-time $75,000
- $85,000 a year 1 day ago Benefits AD&D insurance Paid holidays Disability insurance Health insurance Dental insurance 401(k) Paid time off Employee assistance program Vision insurance Life insurance Qualifications Licensed Clinical Social Worker Patient service Utilization management Clinical documentation Associate's degree Full Job Description Join BasePoint as a Utilization Review Specialist!
What You'll Do:
The UR Specialist is responsible for performing admission approvals, initial and concurrent insurance reviews, and ensures proper utilization of benefits. This position is also responsible for determining appropriate levels of care and ensuring the daily census is accurate. Participates in performance improvement and continuous quality improvement (CQI) activities.Key Responsibilities:
Determine the appropriate level of care for patients based on clinical/medical interview and/or record review, and via consultation with the interdisciplinary clinical and medical teams using American Society of Addiction Medicine Criteria. Identify from insurance company/managed care organizations pre-certification procedures, treatment and discharge plan procedures and transfer procedures. Obtain admission certifications from insurance companies and continue to do concurrent reviews while the patient is admitted. Work with other members of the treatment team to assist in discharge and treatment planning. Communicate with the interdisciplinary team regarding current or future level of care transitions. Report any potential patient safety issues to the interdisciplinary treatment team. On an ongoing basis identify potential certification problems and discuss them with the interdisciplinary team. Communicate with the facility Case Managers regarding EAP referrals, legal entities, disability applications, family and medical leaves, and discharge planning. Communicate with patients and/or their families regarding insurance certification and benefit issues. Review charts for quality of clinical and medical documentation. These concerns have to be communicated to the appropriate team members. Documentation meets standards and policies, and established timeframes. Maintains a good working professional relationship within the department and with other departments.Minimum Qualifications:
Education:
Associate degree requiredExperience:
At least one year of utilization review experience in healthcare required; behavioral health experience strongly preferred.License:
ActiveRN, LPC, LMSW, or LCSW license requiredWhat We Offer:
Medical, Dental & Vision Insurance 401(k) Life Insurance + AD&D Short-Term & Long-Term Disability Accident Insurance, Critical Illness Insurance & Hospital Indemnity Insurance Employee Assistance Program Paid Time Off (PTO) plus 7 Paid Holidays + 2 Floating Holidays A culture of growth, recognition, and celebration The BasePoint Difference- Our Core Values Courage to Solve
- We face challenges head-on, taking responsibility for solutions and acting with integrity. Spirit of Grit
- We bring perseverance, endurance, and passion to everything we do even when it isn't easy. WWIWFMF ("What Would I Want for My Family")
- We deliver the kind of care we'd want for our own loved ones, ensuring the highest standard of excellence. Tend to Your Roses
- We practice servant leadership, caring deeply for our people so they can flourish and thrive.
Pay:
$75,000.00- $85,000.