- Perform Utilization Review - pre-authorization, concurrent and retrospective review as needed for inpatient/or outpatient services and/or predetermination reviews for services or levels of care requiring authorization according to the market requirements and/or policies
- Use clinical expertise and payor knowledge to act as a liaison to treatment team members by utilizing open communication
- Participate in case conferences, clinical in-services, and other educational opportunities
- Maintain all required documentation in the information systems in a timely manner
- Review and identify degree of expertise within UR Band Level with NDoUR
- Perform all other duties as assigned
- Master's degree in counseling; LCSW or BSN in nursing
- Experience in utilization review, case management preferred
- Experience in a business / corporate setting or similar environment is preferred
- Experience in Eating Disorder's preferred
UR Specialist: Remote - Westlake Village, United States - Alsana
Description
The Company
Alsana is an eating disorder recovery community with 10 locations nationwide, plus our virtual program. We provide superior and committed care to help those on their journey to a healthy and successful recovery. From the Latin roots meaning "all" or "total health," Alsana offers a new philosophy of care centered on our clients' full well-being. We address the aspects of eating disorders that often go untreated in traditional recovery programs. Our culture creates a working environment of communication, collaboration, compassion, and integrity-all of which are necessary to craft unique treatment plans tailored to our clients' needs and outcomes.
The Role
As the Utilization Review Specialist at Alsana, you will have a well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. You will be responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data are tracked, evaluated, and reported.
As a UR Specialist, you will effectively and efficiently manage a diverse workload in a fast-paced, rapidly evolving regulatory environment. You will collaborate with multiple leaders at various levels throughout Alsana including directors, leads, and DoCS, for the purpose of supporting and improving the UR Department.
Responsibilities
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