Utilization Review Specialists

Maryhaven - Columbus, OH

Responsible to conduct initial, concurrent and discharge reviews for patients admitted to our inpatient programs. Ensures that documentation is accurate and complete and reflects a true picture of patient’s progress in treatment. Educates members of the treatment team on documentation standards. Works closely with clinicians’ medical staff and to communicate issues regarding discharge planning, length of stay and payor issues. Reports all denials to UR Manager immediately and communicates any issues/problems. Completes appeals for denied services during the initial denial period while the patient is still receiving services. Continues to monitor documentation in the EHR, in order to facilitate appeal success. Must be able to learn different levels of care and differentiate criteria. Also, may be required to complete insurance authorizations for IOP. 

Responsibilities and Duties:

The Utilization Review Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Facilitates clinical pertinence reviews on all patient admissions and continued stays, retrospective reviews, denial appeals, completion of certifications. Overall responsibility for inpatient Utilization Review for assigned patients. Interfaces with managed care organizations, external reviewers and other payors. Serves as a member of the multi-disciplinary team supporting the treatment program and assure the delivery of quality treatment to patients and their family members. Works independently and in collaboration with the UR Director, UR Manager and other members of the clinical and medical staff. Self-directed and self-motivating, plans and conducts work with minimal direction, and reports the progress of work to the UR Director and UR Manager. 

Qualifications and Skills:

Bachelor’s degree or higher from an accredited college or university in social work, mental health or a related field. Minimum one (1) year experience in a substance abuse or mental health setting is required.

Send resume to:

1791 Alum Creek Drive
Columbus, OH 43207
Email: [email protected]

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