Part-Time Utilization Reviewer - Behavioral Health Services

• PRN/As Needed position.
• Weekday, day-time availability is needed.
• Coverage may range from one day a week to consecutive days or weeks.
• Remote employees must live in one of the following states: IL, IN, MO, IA, FL, MI.

Responsibilities:

• Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals.
• Works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies.
• Familiar with DSM diagnoses and ASAM patient placement criteria to communicate patient status to external managed care.
• Communicates insurance input to physicians and clinical staff making discharge plans for patients.
• Assists clinical staff with assessments as needed, primarily as a back-up capacity.
• Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status.
• Understands health care benefit plan provisions and managed care contracting, and communicates benefits and approval status of patients to clinical staff and physicians, and to patients and family members when needed.
• Serves as professional representative of BHS when interacting with reviewers from insurance companies, employers, and managed care plans, and contributes to BHS marketing strategies.
• Communicates and coordinates efforts at appealing unfavorable utilization review decisions, scheduling physician reviews, and monitoring denials and appeals, reporting to Utilization Review Coordinator.

EOE Minorities/Women/Disabled/Veterans. VEVRAA Federal Contractor.

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