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.

Responsibilities

• Determine client medical necessity for insurance claims using various criteria.
• Work to build a case for medical necessity for potential clients.
• Perform pre-intake assessments for potentially viable clients.
• Work closely with treatment team and admissions staff in clinical determination of clients to decide best level of care.
• Conduct chart reviews to ensure clinical documentation matches level of care.
• Ensure authorization matches (correct authorization number, LOC, facility, number of days, and date range).
• Understanding DSM V diagnosis, ICD 10 codes and ASAM criteria and dimensions for all Levels of care.
• Communicate effectively, both written and verbal, with supervisor and staff.
• File appeals for denied cases and follow through.
• Timely, organized documentation. Accurate and thorough record keeping.
• Demonstrate teamwork and professionalism.

Preferred Qualifications

• Master’s Degree
• Licensed LMFT, LCSW, LVN, or RN
• Prior experience in 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

Schedule Flexibility required.

Additional Information

• Diversity is valued.
• EOE.
• Drug-free workplace.
• Pre-employment substance abuse testing.

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