Utilization Review Supervisor

Job Overview
The Utilization Review Senior Supervisor plays a crucial role in obtaining authorizations by performing a variety of functions which incudes, but not limited to, navigating electronic medical records and advocating for the patient; communicating with insurance carriers via phone/ fax as needed, communicating approvals and denials to facilities, articulating medical necessities using specialized language while strictly adhering to compliance standards, managing team members and assigning cases to the team.

Responsibilities

• Manage Utilization Review Team
• Work assigned cases
• Assign cases to team when necessary
• Meet with clients to review medical necessity requirements for each Level of Care
• Evaluate and prepare medical records to justify medical necessity
• Advocate on the client(s) behalf to ensure services will be covered by insurance company
• Ability to adhere to HIPPA compliance standards
• Ability to articulate medical necessity using medical dialect
• Proficient in personal time management, multi-tasking and calendar organization
• Complete new admissions and concurrent reviews in a timely manner
• Review clinical information and communicate documentation needs
• Establish and maintain professional relationships with care managers

Qualifications

• Proficiency with the utilization review process
• In-depth knowledge of the Substance Abuse Facility utilization review process and/or In-depth knowledge of Mental Health utilization review process
• Familiar with ASAM and medical necessity criteria for each level of care
• Effective communication skills, both verbal and written via phone and email
• Proficiency utilizing related software programs such as Kipu, Best Notes, etc.
• Microsoft Office products including Word, Excel, and Power Point
• Knowledge in computers and can navigate various software programs

Education and Experience

• Experience conducting utilization reviews in healthcare setting
• Experience working in mental health and behavioral healthcare setting
• Bachelor’s degree or higher in Psychology or related field

(Preferred but not required):

• Licensed Mental Health Clinician (LCSW, LMHC, LMFT)
• Certified Addiction Counselor or Professional (CAC, CAP, MCAP, MAC)
• Experience working in a medical billing setting
• Experience working in Substance Abuse Treatment Industry
• Experience managing caseloads of 50+ per week
• Experience obtaining an average of 200 authorizations per month
• Knowledge in day-to-day operations of a psychiatric or behavioral healthcare setting
• Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare)

Skills

• Ability to manage a small team while handling caseload
• Strong understanding of physiology and clinical practices related to patient care.
• Experience in utilization review processes, particularly in pediatrics and hospice settings.
• Knowledge of Medicare guidelines and regulations affecting healthcare delivery.
• Excellent communication skills for effective collaboration with healthcare teams.
• Attention to detail and strong analytical skills for reviewing clinical documentation.
• Ability to work independently while managing multiple cases efficiently.

Join our team as a Utilization Review Supervisor and contribute to enhancing the quality of care for our patients through effective utilization management practices.

Job Type: Full-time

Pay: $31.00 - $35.00 per hour

Benefits:

• Paid time off

Work Location: Remote