Utilization Review Clinician

Valley Hope; United States; Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical premiums

Dental & Vision

PTO 27 days

Paid holidays

Parental leave

401k match

Tuition assistance

Student loan support

PSLF eligible employer

HSA & FSA

EAP

Job summary

Valley Hope is seeking an Utilization Review Clinician for a full-time role that can be performed remotely from cities where Valley Hope operates. The position reviews clinical utilization, coordinates with payers, and supports admission decisions within a nationally recognized addiction treatment provider.

The role requires a master’s level licensed clinician or nurse and at least 3 years of behavioral healthcare experience, with preferred 5 years.

Qualifications

• Licensed to practice as a master’s level licensed clinician or nurse in the state of employment.
• Minimum of 3 years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
• Preferred: 5 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 where external payment options exist.
• Serve as a clinical resource for determining admission appropriateness and continued stays.
• Gather required clinical information and report to insurance for authorization of continued stay.
• Maximize certified patient days that are clinically appropriate and available.
• Assist with insurance pre-certifications for admitted patients.
• Appeal denials of certified days when in the best interests of the patient and Valley Hope.
• Communicate patient status with the business office, nursing, and counselor.
• Regularly review medical necessity guidelines for managed care partners.
• Inform staff to assist in discharge planning efforts.
• Complete continuing education credits and adhere to Valley Hope policies.

Skills

Behavioral health counseling

Clinical documentation

Payer coordination

Education

Master’s level licensed clinician or nurse (RN/LPN)

Job description

Overland Park Valley Hope
Leawood, KS 66211, USA

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.

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.
• 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).

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.