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    Utilization Review Specialist - Pasadena, United States - Growth Management

    Growth Management
    Growth Management Pasadena, United States

    1 day ago

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    Description

    Job Description

    Job DescriptionSalary: $90,000

    Founded in 2005, Growth Centers of America network of treatment programs are rapidly growing mental health care companies dedicated to making a difference for our clients, the community, and our employees. We offer an array of mental health services to adolescents and adults with serious mental illness. We partner mostly with insurance companies to provide excellent care to its members. And we're growing all the time When you work at Growth Centers of America, you help to empower hundreds of individuals every day in their journeys of recovery.

    We are actively seeking a utilization review specialist to work in our corporate office in Pasadena, CA. Growth Centers of America understands that an attractive benefits package is important for recruiting above-average candidates. Having said that, we offer a benefits package that includes multiple healthcare plans (Vision, Dental and Medical benefit options, Holiday Pay, Sick Time & Paid Time Off) if eligible.

    Position requires a CA state licensure. Under general supervision and in collaboration with other members of the clinical team authorizes and reviews utilization of mental health and substance abuse services provided in residential treatment programs and/or outpatient care settings. Collects and analyzes utilization data.
    • Monitors residential treatment services and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
    • Ideal candidate performs concurrent reviews for residential inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
    • In conjunction with providers and facilities, develops discharge plans and oversee their implementation.
    • Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the client in treatment.
    • Provides information to clients and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs and company policies and procedures and criteria.
    • Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
    • Participates in quality improvement activities, including data collection, tracking, and analysis.
    • Advocates for the client to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.

    Skill Proficiency Requirements:

    • Dual diagnosis experience with mental health and substance abuse (Advanced)


    • Excellent communication skills (Advanced)


    • Experience in a managed care environment, hospital or residential treatment program (Advanced)


    • Inpatient setting experience (Advanced)


    • Ability to learn and navigate multiple proprietary software applications (Intermediate)


    • Ability to thrive in a fast-paced environment (Intermediate)


    • Rate proficiency with Microsoft Office Suite programs (Word, Outlook, Internet) (Intermediate)

    Certification Requirements:

    • Licensed Master's degree in Psychology, Social Work, Counseling (Required)

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