• Utilization Reviewer

    Job ID
    2018-1935
    # of Openings
    1
    Job Locations
    US-RI-North Kingstown
    Posted Date
    2 months ago(8/22/2018 5:18 PM)
    Category
    Utilization Review (UR)
  • Overview

    Job Summary:

     

    AdCare Rhode Island

     

    The Utilization Reviewer is responsible for completing utilization reviews with insurance companies. This includes pre-certifications, concurrent reviews and discharges. The UR will also be responsible for care management and discharge planning.

     

    Reports To: Director of Admissions

    Responsibilities

    Job Duties:

    • Assist clients in aftercare calls, securing appointments, housing, treatment facilities and providers
    • Works directly with counselors in treatment planning
    • Obtain clients’ pre-certification for treatment
    • Perform concurrent reviews for extended client stays
    • Process appropriate paperwork for client discharge or transfer client level of care
    • Coordinate with clients to secure aftercare appointments with treatment providers such as, OPC, IOP, PDP, Psychiatric Doctors, etc.
    • Facilitate discharge planning by securing transportation, finalizing appointments and completing continuing care form
    • Obtain retroactive authorizations and complete insurance appeals.
    • Collect and track pertinent data on lengths of stay, level of care, etc.
    • Attends supervision provided by the Program Director at least twice a month (group and individual settings)
    • Other duties as assigned

    Qualifications

    Job Requirements:

    • BA in Human Services, Psychology or related field preferred
    • Ability to read, write, communicate and understand directions in English
    • Provide excellent customer service
    • Ability to work independently as well as in a team environment
    • Knowledge of addiction/chemical dependency
    • Strong prioritization/organization and record keeping skills
    • Ability to document patient charts
    • At least two years of prior experience working in addiction/chemical dependency preferred.
    •  Assignments and objectives are set jointly by immediate supervisor and employee
    • Follows “Standard Operating Procedures” (S.O.P.) such as, a unit policy/procedure manual
    • Works alone and checks with the supervisor on deviations from S.O.P.
    •  Makes decisions that are almost always determined by specific instructions or existing policies and procedures  
    • This position requires a TST, MMR Titer and the ability to pass a pre-employment drug screening and background check.
    • If in personal recovery, a minimum of two years continuous abstinence required.
    • Consistently arrive for work on time and adhere to attendance policies
    • Treat clients, visitors and colleagues with dignity and respect; honor each person’s right to privacy; maintain very strict client and colleague confidentiality; respects all individuals’ differences; support cultural diversity in our organization; and follow the core competencies of the Standard of Excellence.

     

     

    AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.

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