Behavioral Health Utilization Review Specialist

Aiken Regional Medical Centers; Spokane (WA); Presencial; USD 65 000 - 90 000; Tempo integral

Resumo da oferta

Aiken Regional Medical Centers seeks a Licensed Behavioral Health Professional to coordinate authorization and reimbursement activities for appropriate care levels across treatment. You will collaborate with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers and obtain service authorization.

The ideal candidate is a licensed behavioral health professional with ASAM criteria expertise and strong advocacy for patients

Qualificações

• Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or related behavioral health field.
• Current state licensure as LCSW/LICSW, LMHC, LPC, LMFT or equivalent behavioral health license.
• Two years of experience in behavioral health and/or SUD treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Strong clinical assessment, documentation, and communication skills.
• Proficiency with electronic health records and Microsoft Office applications.

Responsabilidades

• Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
• Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
• Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
• Assess treatment progress and support continued stay recommendations.
• Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
• Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
• Maintain accurate, timely, and compliant documentation of all utilization review activities.
• Track authorization status and ensure payer deadlines and requirements are met.
• Assist with appeals, reconsiderations, and denial management activities.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Participate in quality improvement efforts related to utilization management and reimbursement processes.

Conhecimentos

ASAM criteria knowledge

DSM-5 knowledge

Clinical assessment

Documentation

EHR proficiency

Communication

Patient advocacy

Formação académica

Master's degree in Social Work/related field

Active LCSW/LICSW or LMHC/LPC/LMFT license

Ferramentas

MS Office

Descrição da oferta de emprego

Aiken Regional Medical Centers seeks a Licensed Behavioral Health Professional to coordinate authorization and reimbursement activities for appropriate care levels across treatment. You will collaborate with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers and obtain service authorization.

The ideal candidate is a licensed behavioral health professional with ASAM criteria expertise and strong advocacy for patients