Responsibilities
Are you caring, compassionate and hardworking? Our facility can provide a place for you to thrive and continue your professional development.
Stonington Institute, a division of one of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS), has an immediate opening for a full-time UR Specialist.
Stonington Institute is committed to providing quality substance abuse treatment options for adults in Southeastern Connecticut and surrounding areas. We offer medical detox as well as residential addictions treatment for active duty and retired military service members in our North Stonington location. Our clinic in Groton, CT, offers partial hospitalization and intensive outpatient treatment.
Job Summary:
The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
Job Duties and Responsibilities
- Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
- Complete initial precertification for all levels of care.
- Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
- Conduct concurrent reviews on assigned cases.
- Ability to identify and advocate for a particular level of care based on the presenting clinical information.
- Coordinate with colleagues and payors regarding client changes in level of care internally or transitions to other internal programs.
- Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
- Learn UR Tracking System, Midas; enter daily authorizations and/or other necessary information in a timely manner.
- Print and monitor UR reports on a daily basis.
- Document and file all authorization information accurately and completely.
- Address client insurance changes immediately and communicate results to appropriate departments.
- Ensure that all applicable information is communicated to the Billing Department on a daily basis.
- Notify UR Department Head and Billing of any denials and complete telephonic or written appeals when necessary.
- Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
- Participate in monthly UR Meeting.
Qualifications
Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment. Knowledge of various treatment levels of care as well as psychiatric diagnosis. Experience with computer skills preferred.
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