- Conduct thorough reviews of client treatment plans to ensure alignment with established clinical guidelines, insurance requirements, and regulatory standards.
- Collaborate with the clinical team to gather and analyze relevant information for utilization review purposes, including treatment progress, goals, and discharge plans.
- Communicate with insurance providers to obtain authorization for treatment services and facilitate ongoing communication regarding the status of clients' treatment.
- Review and interpret insurance policies to determine coverage limitations and exclusions, providing guidance to both the clinical team and clients on potential financial responsibilities.
- Collaborate with the admissions team to assess the appropriateness of admission and continued stay, ensuring that treatment services meet medical necessity criteria.
- Maintain accurate and up-to-date records of all utilization review activities, including documentation of communications with insurance providers, decisions made, and any additional required information.
- Participate in regular meetings with the clinical and administrative teams to discuss individual cases, identify potential issues, and contribute to the development of effective treatment plans.
- Stay informed about changes in insurance regulations, policies, and procedures, and provide training to staff on utilization review best practices.
- Work closely with billing and finance departments to resolve any issues related to claims, denials, or reimbursement for services rendered.
- Ensure compliance with all relevant legal and ethical standards, including privacy and confidentiality requirements.
- Document Clinical duties and observations and directed by the Clinical Director
- Supports to remove logistical barriers to admissions
- Supports the CRM data by tracking leads, admissions, and discharges
- Develops a plan for resident arrival for intake in a timely manner
- Handles the client during entire intake process during transition from once decision made to admit to MTR to their care being handled by their case manager.
- Maintain resident Electronic Health Records (EHR) documents in the resident file
- Provide quality counseling care in a dual diagnosis program
- Build rapport with residents, families, and community referents
- Perform data entry
- Obey HIPAA
- Abide by ethical codes of the APA and CCAPP
- Able to build rapport with residents, families, and community referents
- Able to brand, promote, market, and sell treatment services to prospects
- Able to track leads, admissions, and discharges
- Able to manage an outreach budget and expense report
- Able to travel for outreach
- Able to do data entry for face-to-face meetings
- Able to follow up with leads, families, and referents
- Able to provide education on the services and activities offered
- Able to refer out
- Able to do a screening for treatment
- Able to discuss finances
- Able to arrange for travel
- Able to obey HIPAA
- Abide by ethical codes of the APA and CCAPP
- Current CPR and First Aid Certification on file
- Current TB skin test and health screen report
- Completion of an approved 9-hour RADT Orientation Course consisting of ethics, professional boundaries, and confidentiality or proof of equivalent training/experience.
- Twelve Step Recovery Program
- Social Model detox
- Sales strategies
- Community resources and referral techniques
- Data Entry
- Working with addiction and dual diagnosis
- Knowledge shall include the signs and symptoms of alcohol and other drug intoxication and withdrawal. The handling of medical consultations and referrals shall be a necessity for emergencies.
- Good listener and building rapport
- Good with data entry
- Good with relationships
- Good with screening for services
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Unit Clerk
2 weeks ago
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Customer Services Specialist
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Sr. Behavior Analyst
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BDC Sales Representative
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Patient Access Representative, Admitting
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Client Relations Specialist
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Program Assistant II
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Senior Social Worker
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Public Health Nurse I/II
3 weeks ago
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Utilization Review and Intake Specialist - Fresno, United States - My Time Recovery
Description
Job Description
Job DescriptionSalary: DOEUtilization Review Specialist and Intake Coordinator Job Description
This Utilization Review and Intake Specialist position is versatile, and the duties may change from day to day in this fast-paced environment The ideal Intake coordinator and Case Manager candidate will be able to:
Competencies and Abilities
Qualifications
Knowledge
Skills
Utilization Review and Intake Specialist professionals in Fresno
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Ricardo Hernandez
World class customer service leader