Alternatives In Treatment LLC Hiring for Utilization Review Specialist at West Palm Beach, FL Full Time

Utilization Review Specialist

Job Category |Administrative

Position Type |Full-Time or Part-Time

FLSA | Non-Exempt

Risk Exposure| Low

Location |West Palm Beach, FL

Immediate Supervisor |Utilization Review Supervisor

Position Function/Overview:

This position is responsible for proactively monitoring and assessing clinical documentation and medical records to ensure that medical necessity criteria are met for each level of care. Coordinates with the medical and clinical staff to prepare documentations to present to insurance companies for continued authorization. The focus of our UR Specialist is to manage the review and approval process allowing the clinical and medical staff time to a focus on providing the highest level of care for their patients.

Responsibilities:

• Ensuring adherence to the required HIPPA and documentation requirements as identified by county, state and federal regulatory agencies.
• Maintain confidentiality of records regarding client?s treatment in accordance to HIPAA standards.
• Entering daily activities into central communication system within a specified time period for distribution to contracted facilities.
• Performing initial authorization requests, concurrent reviews, peer reviews, expedited appeals, preparing and submitting charts for chart appeals on Patient engaged in CD/SA.
• Calling requests for initial authorization within one business day of receipt or per insurer guidelines.