Utilization Review Specialist - Behavioral Health (Remote)

Advanced Recovery Systems, LLC; United States; Remote; USD 50,000; Full time

Job summary

An established industry player in behavioral healthcare is seeking a Utilization Review Specialist to bridge the gap between healthcare services and insurance payors. This role is pivotal in ensuring patients receive the necessary treatment by reviewing medical documentation and advocating for their needs. You will engage with managed care companies, coordinate with multidisciplinary teams, and contribute to the healing journey of individuals facing addiction and mental health challenges. If you are passionate about making a difference and have the skills to navigate complex healthcare systems, this is a rewarding opportunity to join a dedicated team committed to long-term recovery.

Benefits

Free Teladoc access

401(k) matching

Medical, dental, and vision insurance

Generous vacation time

Employee Referral Bonus up to $4000

Qualifications

• 3+ years experience in psychiatric or chemical dependency settings.
• Bachelor's degree in health-related field required.

Responsibilities

• Conduct pre-authorizations and concurrent reviews for patient treatment.
• Coordinate with insurance companies and treatment teams.

Skills

Communication Skills

Organizational Skills

Time Management

Problem-Solving

Multitasking

Education

Bachelor’s degree in a health or behavioral health related field

Graduate degree in a health or behavioral health related field

High School diploma or equivalent

Tools

UR Census Report

Job description

Overview

Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, and mental health issues. We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns.

At Advanced Recovery Systems, we are committed to the journey of long-term recovery for our patients. As a Utilization Review Specialist, you play a critical role in this mission by serving as the vital link between our healthcare services and insurance payors. Your expertise in reviewing medical documentation, advocating for necessary treatment, and coordinating with insurance companies ensures that our patients receive the appropriate duration and level of care. This position is not just about phone calls and paperwork; it’s about enabling life-changing treatment for those in need by making sure it’s financially accessible and justified. Join us in making a tangible difference in the lives of our patients and their families. Your role is not just important; it’s integral to the healing process.

What we offer:

• Starting pay $50,000/yr, based on experience.
• Free Teladoc access and visits to employee and eligible dependents!
• Benefits begin on the 1st day of the month following date of hire.
• Matching HSA - up to $1500/yr contribution from the company to your HSA.
• 401(k), medical, dental, vision, and generous vacation time!
• Employee Referral Bonus - you can earn up to $4000.

Take the first step toward making a difference and saving lives.

Responsibilities

The Utilization Review Specialist (UR Specialist) is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews throughout the duration of patient’s treatment stay, and assists the treatment team in understanding the different requirements that various insurance companies have for admission, continued stay and discharge planning.

Core Job Duties:

• Completes pre-authorizations/concurrent reviews/internal UR reviews.
• Consults with various members of the multidisciplinary treatment team concerning required information to complete concurrent reviews.
• Schedules peer to peer reviews and coordinates urgent/expedited appeals.
• Staffs individual cases with MDs as needed.
• Follows all standard ARS Utilization Review Department policies and procedures.
• Utilizes the UR Census Report on a daily basis.
• Makes all initial calls within 24 hours, and follow up calls every 24 hours.

Other Required Tasks:

• Data entry, records management and assisting with the appeals process.
• Completing detailed daily documentation.
• Works with Finance Department regarding client service authorizations.
• Communicating frequently with the treatment team.
• Other duties as assigned.

Position Competencies:

• Proficiency in establishing and maintaining positive and effective communication with managed care companies.
• Ability to align medical and counseling staff to ensure services are provided at the appropriate level of care in a timely manner consistent with the patient’s condition and in compliance with governmental and accrediting agencies.
• Ability to be resourceful and proactive in dealing with issues that may arise.
• Demonstrate the ability to organize, multitask, prioritize and work under pressure.
• Effective time management.

Qualifications

• Bachelor’s degree in a health or behavioral health related field required, Graduate degree in a health or behavioral health related field preferred,OR
• High School diploma or equivalent and a State license (e.g., Registered Nurse, Licensed Practical Nurse, LCSW, LMHC) preferred.
• Minimum of three years’ experience working in a psychiatric or chemical dependency setting.
• Minimum of three years’ Utilization Review experience preferred.
• State licensure preferred (Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor).

We offer great benefits including 401(k), paid time off plan, medical, dental, vision, and much more.

Advanced Recovery Systems, a national integrated behavior healthcare management company dedicated to the treatment of addiction, substance abuse, eating disorders and mental health issues. We invite you to learn more about us at our website!

We are proud to be a drug-free workplace.