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 our clients. The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight timeline.

1. Determine client medical necessity for insurance claims using various criteria and dimensions as dictated by the insurance carriers.
2. Work to build a case for medical necessity for potential clients.
3. Perform pre-intake assessments for potentially viable clients.
4. Work closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of care.
5. Conduct chart reviews to ensure clinical documentation matches level of care requested.
6. Ensure that authorization matches the authorization obtained by you for the correct authorization number, the LOC, the facility, the number of days and the date range.
7. Understanding DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all Levels of care.
8. Communicate effectively, both written and verbal, with supervisor and all pertinent staff on your clients.
9. File appeals for denied cases and follow through on that process.
10. Timely, organized documentation. Record keeping must be accurate and thorough.
11. Demonstrate the ability to act as a team player in a professional and positive manner.

Preferred Qualifications

• Master’s Degree
• Licensed LMFT, LCSW, LVN, or RN
• Prior experience in doing utilization review for substance use facilities
• Strong knowledge of ASAM dimensions 1-6
• Knowledge of DSM-V Codes
• Knowledge of SUD, IOP, and Mental Health programs

Flexibility with schedule to meet critical deadlines is essential.

Not sure if you meet all the qualifications? Apply anyway!

To provide truly innovative care, we need a diverse team.

Discovery Behavioral Health is committed to creating an inclusive environment.

If you find yourself meeting some but not all of the above, we would be happy to consider your application.

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