Utilization Review Specialist

Santa Barbara Cottage Hospital; Louisiana; Remote; USD 55,000 - 75,000; Full time

Job summary

Odyssey House Louisiana, Inc. is seeking a full-time Utilization Review Specialist for a remote opportunity. The role involves collaborating in a multidisciplinary team to ensure high-quality patient care through thorough reviews of treatment plans and compliance with standards. Ideal candidates possess a Master's degree and have a solid background in case management and substance use disorder reviews. This position offers a competitive benefits package to support the well-being of employees.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Benefits

401k Match

Qualifications

• 1 year of case management experience required.
• Familiarity with ASAM criteria required.
• Strong analytical skills preferred.

Responsibilities

• Obtain pre-certification and continued stay authorizations using ASAM criteria.
• Review patient records for compliance with reimbursement policies.
• Assist in quality assurance reviews and peer-to-peer conferences.

Skills

Communication

Analytical Skills

Familiarity with ASAM Criteria

Education

Master’s degree in Counseling, Social Work, Psychology, or related helping profession

Tools

MS Office 365

Job description

*Position allows remote work; must reside in New Orleans or surrounding area.

Join our mission to provide a comprehensive continuum of care for people in Louisiana, encompassing primary care, behavioral health, and substance use disorder treatment. Help save lives at OHL!

Job Summary

Odyssey House Louisiana, Inc. is seeking full-time Utilization Review Specialists. This is a remote position, Monday-Friday, 8am-5pm. The position provides high-quality, client-focused healthcare services that meet the assessed and individually planned needs of all clients. The Utilization Review Specialist will work as part of the multi-disciplinary team (MDT) and is responsible for maintaining standards of care and competency, ethical treatment of patients, understanding of addiction and medications used for detoxification, managing withdrawal symptoms with comprehensive triage, consistent documentation on care, review, and implementation of treatment orders.

Responsibilities and Duties

The Utilization Review Specialist's duties include:

• Obtaining pre-certification and continued stay authorizations using ASAM criteria to review clinical information with insurance companies;
• Communicating with clients to obtain and relay necessary clinical information;
• Communicating authorization information internally to enable billing processes;
• Analyzing insurance, governmental, and accrediting standards concerning admissions, treatment, and length of stay;
• Reviewing patient records to determine legitimacy of admission, treatment, and stay to ensure compliance with reimbursement policies;
• Reviewing applications and assisting in approval for patient admission or referring cases to the Admissions Supervisor;
• Comparing inpatient records to established criteria and consulting with medical staff to determine treatment legitimacy;
• Reporting and maintaining statistics from medical records;
• Determining patient review dates according to diagnostic criteria;
• Assisting in quality assurance reviews and peer-to-peer conferences;
• Conducting health information groups as requested;
• Completing census and documentation daily;
• Transcribing relevant paperwork for MDT;
• Reviewing individual patient needs with medical staff;
• Supporting delivery of patient care;
• Participating in monthly in-services;
• Assisting with clinical authorizations;
• Communicating effectively with insurance providers;
• Maintaining a clean and organized work environment;
• Upholding professionalism and patient privacy under HIPAA;
• Making rounds with nursing staff;
• Performing other duties as assigned.

Qualifications and Skills

Required:

• Master’s degree in Counseling, Social Work, Psychology, or related helping profession;
• Familiarity with ASAM criteria;
• At least 1 year of case management experience;
• Proficiency in MS Office 365;
• Excellent communication skills.

Preferred:

• 1 year of EHR and Practice Management experience;
• 2+ years of substance use disorder utilization review experience;
• Knowledge of ASAM criteria, substance abuse treatment, and HIPAA;
• Strong analytical skills.

Compensation and Benefits

Competitive package includes health, dental, vision, life insurance, disability, leave benefits, and 401k match.

Odyssey House Louisiana, Inc. is an EEO employer - M/F/Vets/Disabled