Utilization Review Specialist - Stoughton, United States - Gosnold
Description
OVERVIEW:
Gosnold, Inc.
has been a nationally accredited non-profit leader in the prevention, treatment and recovery of mental health and substance use disorders for over 50 years.
We offer a full, end-to-end continuum of care offering a wide range of treatment options.Highly regarded for innovation, we offer a comprehensive patient centered continuum of care tailored to fit the needs of each individual.
Gosnold welcomes like-minded individuals who are passionate about our mission to support people and families affected by these disorders, and to promote lasting recovery.
SUMMARY:
The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient's insurance plan.
ESSENTIAL JOB FUNCTIONS/DUTIES/RESPONSIBILITIES:
- Working knowledge of managed care principles with preference for experience in dual diagnosis.
- Consult with clinical staff to coordinate recommendations for intervention strategies and authorizations for continued care.
- Provide technical assistance to staff with care coordination activities as needed.
- Prepare and present cases for physician when necessary for doctortodoctor reviews.
- Document and record authorizations and UR results in the computer system. Record and report to treatment teams the progress and expectations for the next UR review.
- Daily communication and education with the treatment teams about the member's insurance benefits and aid them in coordinating the most comprehensive after care for the patient.
- Provide information to managed care providers about alternative levels of care within the Gosnold system and accurately promotes these services.
- Perform all other duties as assigned.
MINIMUM KNOWLEDGE, EXPERIENCE, AND SKILLS REQUIRED:
- The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform the job._
Education:Master's
degree in social work, psychology, mental health or addiction required.
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Experience: Experience in performing utilization review and/or providing clinical services in an intensive treatment setting is preferred and at least (two) 2 years of clinical experience in delivery of health services. Knowledge of clinical criteria required for various levels of care.
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Skills:Computer literacy and ability to learn and use behavioral health software programs. Good communication, interpersonal, and organizational skills.
Certificates, Licenses, and Registrations:
N/A
BENEFITS (based on full-time employment):
- Blue Cross & Blue Shield health and dental insurance
- Vision insurance
- Medical and dependent care flexible spending accounts
- Generous paid vacation, sick, and holiday time
- 403b retirement savings plan with employer match
- Personal financial management services
- Life and supplemental life insurance
- Critical illness and accident insurance
- Family First caregiver benefit
- Employee Assistance Program
- Pet insurance
- Tuition assistance
- Payroll deductions for home and automobile insurance
Equal Opportunity Employer.
COVID-19 Statement:
In accordance with CDC guidelines, Gosnold maintains strict standards when it comes to protecting our staff, patients, and residents, and offers a variety of personal protective equipment to ensure a safe and stress-free workplace.
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