Athens Addiction Recovery Center Hiring for Utilization Review Specialist at Athens, GA Full Time

About
Serenity Grove (SG), a comorbidity treatment center, providing individual and group therapy in a residential setting for alcohol & drug substance use disorders and co-occurring metal health diagnosis. We employ gold standard, evidence-based treatment modalities and curricula.

Convenient to the 10-loop bypass, Atlanta and suburbs via Highway 316, our treatment center is an easy commute. We are proud to be Joint Commission accredited.

Virtual tour: https://youtu.be/dbhEX2Xk6w4

Athens, GA

Job details:
Job Type: Career Position; Full-time or Part-time

Job Description:
Proactively monitors appropriate utilization of services and optimizes reimbursement and lengths of stay to the benefit of clients. This position may be Full or Part time.

Duties:

• Perform utilization reviews (concurrent reviews)
• Document all review and authorization information in a manner compliant with organizational and payer policies and standards of care
• Work independently in gathering information for reviews from the client record and by attending treatment team meetings for each treatment plan
• Obtain insurance authorization for all admitting clients,including those returning to treatment or requiring pre-authorization
• Contact MCOs for all level of care increase requests within an hour upon the request
• Prepare and submit appeals to MCOs. Schedule peer review and appeals with appropriate clinical staff
• Notify appropriate clinical staff of all results from concurrent/peer reviews and appeals
• Communicate all discharge clinical information to MCOs and required parties
• Provide immediate communication to families once continued authorization for treatment has been denied. Review the Non-Covered Services Agreement with families and obtain a completed form with signature for continued treatment
• Review and update error s and collaborate with the finance department
• Other duties as assigned

Competencies:

• Crisis Management Skills; AMA Prevention Interventions & Training for other staff
• Knowledge of CPR and First Aid Procedures
• Negotiation Skills
• Joint Commission/HIPAA Standards
• Managed care (verification, negotiating rates, and pre-certification)
• Knowledge of emergency procedures for fire, disaster and unplanned incidents.
• Medical Records documentation requirements and notification of deficits when encountered
• Medical records confidentiality and disclosure laws.
• Clinical skills
• Computer skills

Proficiencies:
Candidate must demonstrate interpersonal management with a high level of written and verbal communication skills. Candidate will interface regularly with medical and behavioral health staff, clients, families and various managed care companies. Time management skills are a must.

Qualifications:
Required: a degree in counseling, social work, nursing, or other human service field.
Experience: Prefer substance use disorder treatment experience (personal or professional) or a minimum of 1 year experience in a behavioral health setting such as an outpatient clinic, residential treatment facility or psychiatric hospital.

Job Type: Full-time or Part-time

Job Types: Full-time, Part-time

Pay: $31.00 – $41.00 per hour

Benefits:

• Flexible schedule
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: In person