Utilization Review Clinician

Valley Hope Addiction Treatment & Recovery; Leawood (KS); Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical coverage up to 85% of premiums

Dental & vision plans

Up to 27 days PTO

8 paid holidays

Paid parental leave

401(k) with employer match

Tuition assistance

Student loan repayment support

PSLF eligible employer

EAP

Job summary

Valley Hope Addiction Treatment & Recovery is seeking an Utilization Review Clinician for a full-time, remote-capable role. The position supports review and coordination of clinical utilization and payer expectations for patient admissions with external payment options.

The role serves as a clinical resource for determining admission appropriateness and continued stays, gathering required information for insurance authorization, and maximizing clinically appropriate patient days.

Qualifications

• Master's level licensed clinician or nurse with state licensure.
• Three years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.

Responsibilities

• Review and coordinate clinical utilization and external payer expectations for each patient admission with external payment options.
• Act as a clinical resource to determine appropriateness of admission and continued stays.
• Gather required clinical information and report to insurance providers to obtain authorization for continued stay.
• Maximize certified patient days that are clinically appropriate and available as benefits.
• Assist with insurance pre-certifications for patients admitted to treatment.
• Appeal denials of certified days when in the patient and Valley Hope's best interests.
• Communicate patient status with the business office, nursing, and counselors.
• Review medical necessity guidelines for managed care partners and assist with discharge planning information.

Skills

Clinical counseling

Utilization review

Communication

Education

Master's level licensed clinician or nurse (LCSW/LSW/LMFT/RN/LPN)

Licensed to practice in state of employment

Job description

Utilization Review Clinician: Full-Time ; Monday - Friday 8:00am - 5:00pm

Valley Hope has an exciting full-time opportunity for an Utilization Review Clinician to join our team. This position can be performed remotely by candidates residing in cities in which Valley Hope operates.

With a near 60-year legacy of helping patients and families, Valley Hope is nationally known as a trusted provider of addiction treatment and recovery support. Since treating our first patient in 1967, Valley Hope has established a national footprint, with 16 treatment programs across the United States, with multiple locations in Colorado, Kansas, Missouri, Nebraska, Oklahoma, and Texas. We have helped more than 350,000 people find hope in recovery and restore their lives.

Valley Hope restores lives affected by addiction and supports lifelong recovery. At Valley Hope, our mission comes to life through our core values of Character, Compassion, and Commitment. Are you ready to join an organization where you can make an extraordinary impact, conquering addiction one patient and family at a time? If so, Valley Hope welcomes you!

Valley Hope values our employees and works intentionally to ensure employee satisfaction, support, and professional development. Our compassionate culture, built over more than five decades, is foundational to the success of our patients and the care we provide.

Education & Experience

Required:

• Licensed to practice as a master's level licensed clinician or nurse (RN or LPN) in the state of employment.
• Three years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.

Preferred

• Five years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
• Previous utilization review and/or utilization management experience

Compensation

• Starting salary ranges from $64,000 - $95,000 (Based on experience & education)

Benefits

• Medical coverage - Valley Hope pays up to 85% of premiums
• Dental & vision plans at competitive rates
• Up to 27 days of PTO (based on position and tenure)
• 8 paid holidays (including a personal day)
• Paid parental leave
• 401(k) with employer match
• Tuition assistance to grow your career
• Student loan repayment support
• Public Student Loan Forgiveness (PSLF) eligible employer
• HSA & FSA options to manage healthcare costs
• Employee Assistance Program (EAP) for added support
• And more perks designed with you in mind!

Job Summary

• Provide support services to review and coordinate clinical utilization and external payer expectations for each patient admission where external payment options exist.
• Serve as a clinical resource person for the health care team when determining appropriateness of admission and continued stays.
• Gather required clinical information and report to insurance company's patient's progress and plan to receive authorization for continued stay.
• Maximize certified patient days that are clinically appropriate and available as benefits
• Obtain and assist with insurance pre-certifications for patients who are admitted to treatment.
• Appeal denials of certified days when it is in the best interests of both the patient and Valley Hope to do so.
• Effectively communicate patient status information with the business office, nursing, and counselor.
• Regularly review medical necessity guidelines for managed care partners.
• Communicate information to appropriate staff members to assist in discharge planning efforts.
• Provide effective documentation to Valley Hope contract physicians and/or other clinical staff to assist with peer to peer reviews.
• Inform UR Manager of any ongoing trends/issues occurring with managed care companies.
• Completes any required continuing education credits.
• Maintains current state license/certification.
• Adheres to Valley Hope's clinical philosophies, policies, and procedures as well as any other regulating bodies to ensure quality patient care.
• Participates in all assigned staff meetings, staff development, and training as required.
• Interacts and communicates with others (patients, co-workers, management, and vendors) in a professional and tactful manner including treating them with respect and consideration regardless of their status or position.

Work Environment

• Sitting for extended periods of time; regularly talking to and listening to others.
• Able to work at a rapid pace for long periods of time (typically no longer than 8 hours).