SUNRISE HOUSE Utilization Review/Case Management

Job Summary:

Coordinates and performs Utilization Review/Case Management functions; primarily focuses on concurrent reviews and apples/denials.

Reports To: Director of Patient Services            

Job Duties:

• Be involved in the treatment planning process and determination of the appropriate levels of care.
• Initiate appeal process on all appropriate cases to facilitate compensation for services rendered.
• Establish optimum communication between departments and patients regarding patient benefits and approved treatment days (certification), and patient’s rights and responsibilities in cases of denial of payment.
• Supports and promotes an environment of Customer Service.
• Gathers all clinical and medical information, in the operating platforms, required to determine level of care. Meets with patient and/or reviews information provided by family if needed.
• Discusses any medical/psychiatric concerns with direct Supervisor, Medical Director, or CEO if indicated.
• Completes and updates the required UR assessments and associated areas in operating platforms as needed.
• Completes and updates data in operating platforms as required for billing.
• Monitors and manages all email correspondence.
• Maintains compliance with AAC policies and Procedures
• Maintains compliance with State regulations and accreditation standards.

Job Requirements:

• High school graduate or equivalent.
• Education background sufficient to demonstrate professional competency in utilization review and quality assurance, as evidenced by a college degree in health administration, social work, or nursing. Work experience with appropriate certification/credentials may be substituted for a professional degree.
• Familiarity with alcohol and substance abuse treatment, state licensure, and national accreditation in health care settings.
• Ability to initiate, maintain, and promote good interpersonal relationships.
• Good verbal and written communication skills.
• Ability to maintain patient confidentiality.
• Strong computer skill.

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.