Full-Time Utilization Review Case Manager

Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for clients.

Submit accurate utilization reviews on a tight timeline.

1. Determine client medical necessity for insurance claims.
2. Work to build a case for medical necessity.
3. Perform pre-intake assessments.
4. Work closely with treatment team and admissions staff in clinical determination of clients.
5. Conduct chart reviews to ensure clinical documentation matches level of care.
6. Ensure authorization match (authorization number, LOC, facility, days, date range).
7. Understand DSM-V diagnosis, ICD-10 codes, and ASAM criteria and dimensions for all levels of care.
8. Communicate effectively (written and verbal) with supervisor and staff.
9. File appeals for denied cases.
10. Timely, organized documentation. Record keeping must be accurate and thorough.
11. Demonstrate teamwork and professionalism.

What is the last date for applying to the job?

Which countries are accepted for this remote job?