- obtain pre-certification and continued stay authorizations onbehalf of the patient and provider using ASAM (American Society of AddictionMedicine) criteria to review clinical information with insurance companies;
- communicate with clients to obtain and relay necessary clinicalinformation;
- communicate authorization information internally within the agencyto enable the stages of the billing process to take place;
- analyzes insurance, governmental, and accrediting agency standardsto determine criteria concerning admissions, treatment, and length of stay ofpatients;
- analyze patient records to determine legitimacy of admission,treatment, and length of stay in the health-care facility to comply withgovernment and insurance company reimbursement policies;
- review applications and assist in approval for patient admissionor refer cases to the Admissions Supervisor for review and course of actionwhen case fails to meet admission standards;
- compare inpatient medical records to established criteria andconfer with medical, nursing, and other professional staff to determinelegitimacy of treatment and length of stay;
- report out and maintain statistics on data from medical records;
- determine patient review dates according to established diagnosticcriteria;
- assist review committee in planning and holding federally mandatedquality assurance reviews;
- aid in initial and concurrent/continued stay reviews and arrangepeer to peer conferences;
- conduct health information groups as requested by the SeniorProgram Manager;
- complete accurate census and count on all clients daily asinstructed by the Admissions Supervisor;
- transcribe relevant paperwork for MDT;
- review individual patient needs with medical doctor as needed;
- assist support staff in delivery of patient care;
- participate in monthly in-services;
- assist Admissions Supervisor with clinical authorizations;
- communicate effectively with insurance providers;
- maintain a clean, organized work environment;
- maintain professionalism with staff members and clients at alltimes;
- maintain privacy of patients by protecting health informationprotected under Health Insurance Portability and Accountability Act;
- make rounds with nursing staff during visits; and
- perform other duties as assigned.
- High School Diploma or equivalent
- At least 1 year of case management experience
- 6 months substance abuse treatment experience
- Proficient in MS Office Suite
- Associates Degree in a related field
- 1 year of Electronic Health Record and Practice Managementexperience
- 2 plus years of substance abuse utilization review experience
- Familiarity with ASAM criteria, substance abusetreatment, and HIPAA
- Excellent comprehension and analytical skills
- Excellent customer service skillsCompensation and BenefitsCompetitivecompensation and benefits package includes insurance (health, dental, vision,life, long-term and short-term disability), leave benefits and 401k match. Odyssey House Louisiana, Inc. is an EEO employer - M/F/Vets/Disabled
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Utilization Review Specialist - New Orleans, United States - Odyssey House Louisiana
Description
Compensation Range:
$19.25/hr.
Utilization Review Specialist-Residential ProgramJoinour mission to provide a comprehensive continuum of care for people inLouisiana, encompassing primary care, behavioral health, and substance usedisorder treatment.
Help save lives at OHLJob SummaryOdyssey House Louisiana, Inc. is seeking full-time UtilizationReview Specialists for the Adult Residential program. The schedule for theposition is Monday-Friday 8am-5pm.This position provides high qualityclient-focused health care services that meet the assessed and individuallyplanned needs of all clients in the Residential Program.
The Utilization ReviewSpecialist will work as a part of the multi-disciplinary team (MDT) and isresponsible for maintaining standards of care and competency, ethical treatmentof patients, understanding of addiction and the medications used fordetoxification purposes, managing symptoms of withdrawal with comprehensivetriage, consistent documentation on care, review and implementation oftreatment orders.
Responsibilities and DutiesIt is the duty and responsibility of the Utilization ReviewSpecialist to:Qualifications and SkillsRequiredMinimumqualifications include the following:
