Remote Utilization Review Clinician

Northpoint-Recovery-Holdings,-LL; Meridian (ID); On-site; USD 48,000 - 55,000; Full time

Benefits offered by this job

Subsidized Health Insurance Coverage

Employer Paid Life Insurance

Employee Assistance Program

Dental, Vision, Short-Term Disability,

Pre-tax Savings Accounts

Generous Paid Time Off

Job summary

Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care and cost-effective utilization across the treatment continuum for the Northpoint Recovery and Imagine by Northpoint programs. The UR Specialist collaborates with a multidisciplinary team, reviews admissions, stays, discharges, and appeals with payers and care teams.

This full-time, remote role requires a Master’s degree in social sciences or equivalent experience, active

Qualifications

• Master’s degree in social sciences or commensurate experience.
• Active substance use or mental health licensure in the state where treatment services are rendered.
• Maintain applicable state licensure requirements for the duration of employment.
• Minimum 1 year of experience in a relevant field.
• Ability to exercise discretion and professional boundaries with client information.
• Ability to apply clinical judgment and ethics to treatment plans and documentation.
• Ability to build rapport with patients and staff while maintaining confidentiality.
• Adhere to ethical standards of licensure governing board.

Responsibilities

• Apply utilization criteria to monitor admission appropriateness and levels of care.
• Communicate with third-party payers for initial and concurrent clinical review.
• Review patient charts for ongoing medical necessity.
• Document actions and share information with care teams and payers.
• Discuss with clinical care team and management when medical necessity criteria are not met.
• Refer cases exceeding LOS, cost, or utilization to management.
• Conduct verbal/fax reviews with payers as appropriate.
• Collect data on LOS variances, days lost, and discharge barriers.
• Prepare appeals for denied cases when appropriate.
• Interact effectively with patients, families, payers, and staff.

Skills

Excellent critical thinking skills

Excellent organizational abilities

Excellent communication skills

Problem solving

Analytical reasoning

Attention to detail

Confidentiality

Interpersonal communication

Multitasking

Prioritization under pressure

Microsoft Office Suite

Education

Master’s degree in social sciences

Active substance abuse or mental health licensure

Tools

Microsoft Office Suite

Job description

Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care and cost-effective utilization across the treatment continuum for the Northpoint Recovery and Imagine by Northpoint programs. The UR Specialist collaborates with a multidisciplinary team, reviews admissions, stays, discharges, and appeals with payers and care teams.

This full-time, remote role requires a Master’s degree in social sciences or equivalent experience, active