Utilization Review Specialist

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $30 - $35 / hour

⏰ Full Time

🟢 Junior

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Northpoint Recovery

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🏥 Healthcare

Healthcare • Mental Health • Addiction Treatment

Northpoint Recovery is a comprehensive addiction treatment center located in Boise, Idaho, offering a range of services for adults and teens struggling with substance use disorders and co-occurring mental health issues. They provide tailored inpatient and outpatient programs that include detox, individual therapy, and evidence-based treatments like cognitive behavioral therapy, all designed to support lasting recovery and relapse prevention. With a focus on compassionate care and a therapeutic environment, Northpoint Recovery aims to help clients build healthier futures and achieve sobriety.

📋 Description

• Ensure clinically appropriate care, discharge, and cost-effective utilization of services across the treatment continuum • Provide ongoing clinical review of patients from admission through discharge in conjunction with a multidisciplinary team • Lead timely and clinically sound reviews and responses for admissions, continued stays, discharges, and appeals • Serve as a liaison between payers and clinical care teams • Apply utilization criteria to monitor admissions, levels of care, and continued stays • Communicate with third-party payers for initial and concurrent clinical review • Review patient charts to ensure continued medical necessity • Document actions and information shared with care team members or third-party payers • Alert clinical care teams and management when patients no longer meet medical necessity criteria • Refer cases exceeding expected length of stay, cost, or resource utilization to management • Perform verbal/fax clinical reviews with payers • Collect data on length-of-stay variances, lost days, costs, discharge barriers, transitions, and denied days • Prepare appeals on denied cases when appropriate • Adhere to company policies, confidentiality requirements, and standards of care • Perform other job-related duties as assigned

🎯 Requirements

• Master’s Degree of Social Sciences or commensurate experience required • Must hold an active substance abuse or mental health licensure in the state where treatment services are rendered • Must maintain applicable state licensure requirements at hire, and for the entire duration of employment • 1+ year of experience in relevant field required • Must be able to exercise discretion and independent judgment in all areas of job performance including adherence to appropriate professional boundaries and strict confidentiality practices in regard to client activities and documentation • Able to apply clinical judgment, ethics and accountability to formulate and implement treatment plans and other clinical documentation • Must hold strong personal boundaries and able to build rapport with patients and staff • Must understand and adhere to the ethical standards of the respective licensure governing board • Excellent critical thinking skills • Excellent organizational abilities • Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing • Quickly and effectively identify and resolve problematic situations • Comfortable analyzing information and dealing with complexity • Attention to detail and accuracy • Able to handle confidential material in a reliable manner • Ability to interact and communicate with individuals at all levels of organization • Ability to perform several tasks concurrently with ease and professionalism • Ability to effectively prioritize workload in a fast-paced environment • Proficiency with Microsoft Office Suite • Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA

🏖️ Benefits

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s) • 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000 • 100% Employer Paid Employee Assistance Program • Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance • Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses • Generous Paid Time Off plan • Employee Referral Bonuses • 401K Retirement Plan & Employer Match

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