Odyssey House Louisiana
Utilization Review Specialist
Odyssey House Louisiana, New Orleans, Louisiana, United States, 70123
Overview
Join to apply for the
Utilization Review Specialist
role at
Odyssey House Louisiana .
This is a full-time remote position (must reside in New Orleans or surrounding area) with hours Monday–Friday, 8:00 a.m. – 5:00 p.m.
Job Summary Odyssey House Louisiana, Inc. is seeking full-time
Utilization Review Specialists . This is a remote position (must reside in New Orleans or surrounding area) Monday-Friday 8am-5pm. This position provides high quality client-focused health care services that meet the assessed and individually planned needs of all clients. The Utilization Review Specialist will work as a part of the multi-disciplinary team (MDT) and is responsible for maintaining standards of care and competency, ethical treatment of patients, understanding of addiction and the medications used for detoxification purposes, managing symptoms of withdrawal with comprehensive triage, consistent documentation on care, review and implementation of treatment orders.
Responsibilities and Duties
Obtain pre-certification and continued stay authorizations on behalf of the patient and provider using ASAM (American Society of Addiction Medicine) criteria to review clinical information with insurance companies.
Communicate with clients to obtain and relay necessary clinical information.
Communicate authorization information internally within the agency to enable the stages of the billing process to take place.
Analyze insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
Analyze patient records to determine legitimacy of admission, treatment, and length of stay in the health-care facility to comply with government and insurance company reimbursement policies.
Review applications and assist in approval for patient admission or refer cases to the Admissions Supervisor for review and course of action when case fails to meet admission standards.
Compare inpatient medical records to established criteria and confer with medical, nursing, and other professional staff to determine legitimacy of treatment and length of stay.
Report out and maintain statistics on data from medical records.
Determine patient review dates according to established diagnostic criteria.
Aid in initial and concurrent/continued stay reviews and arrange peer-to-peer conferences.
Conduct health information groups as requested by the Senior Program Manager.
Complete accurate census and count on all clients daily as instructed by the Admissions Supervisor.
Transcribe relevant paperwork for MDT.
Review individual patient needs with medical doctor as needed.
Assist support staff in delivery of patient care.
Participate in monthly in-services.
Assist Admissions Supervisor with clinical authorizations.
Communicate effectively with insurance providers.
Maintain a clean, organized work environment.
Maintain professionalism with staff members and clients at all times.
Maintain privacy of patients by protecting health information protected under HIPAA.
Make rounds with nursing staff during visits; and
Perform other duties as assigned.
Required Qualifications and Skills
Master’s degree in a Counseling, social work, psychology and another helping profession
Familiar with ASAM (American Society of Addiction Medicine) criteria
At least 1 year of case management experience
6 months substance abuse treatment experience
Proficient in MS Office 365 Suite
Excellent written and verbal communication skills
Preferred
1 year of Electronic Health Record and Practice Management experience
2 plus years of substance use disorder utilization review experience
Familiarity with ASAM criteria, substance abuse treatment, and HIPAA
Excellent comprehension and analytical skills
Excellent customer service skills
Compensation And Benefits Competitive compensation and benefits package includes insurance (health, dental, vision, life, long-term and short-term disability), leave benefits and 401k match.
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Medical Practices, Hospitals and Health Care, and Veterinary Services
#J-18808-Ljbffr
Utilization Review Specialist
role at
Odyssey House Louisiana .
This is a full-time remote position (must reside in New Orleans or surrounding area) with hours Monday–Friday, 8:00 a.m. – 5:00 p.m.
Job Summary Odyssey House Louisiana, Inc. is seeking full-time
Utilization Review Specialists . This is a remote position (must reside in New Orleans or surrounding area) Monday-Friday 8am-5pm. This position provides high quality client-focused health care services that meet the assessed and individually planned needs of all clients. The Utilization Review Specialist will work as a part of the multi-disciplinary team (MDT) and is responsible for maintaining standards of care and competency, ethical treatment of patients, understanding of addiction and the medications used for detoxification purposes, managing symptoms of withdrawal with comprehensive triage, consistent documentation on care, review and implementation of treatment orders.
Responsibilities and Duties
Obtain pre-certification and continued stay authorizations on behalf of the patient and provider using ASAM (American Society of Addiction Medicine) criteria to review clinical information with insurance companies.
Communicate with clients to obtain and relay necessary clinical information.
Communicate authorization information internally within the agency to enable the stages of the billing process to take place.
Analyze insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
Analyze patient records to determine legitimacy of admission, treatment, and length of stay in the health-care facility to comply with government and insurance company reimbursement policies.
Review applications and assist in approval for patient admission or refer cases to the Admissions Supervisor for review and course of action when case fails to meet admission standards.
Compare inpatient medical records to established criteria and confer with medical, nursing, and other professional staff to determine legitimacy of treatment and length of stay.
Report out and maintain statistics on data from medical records.
Determine patient review dates according to established diagnostic criteria.
Aid in initial and concurrent/continued stay reviews and arrange peer-to-peer conferences.
Conduct health information groups as requested by the Senior Program Manager.
Complete accurate census and count on all clients daily as instructed by the Admissions Supervisor.
Transcribe relevant paperwork for MDT.
Review individual patient needs with medical doctor as needed.
Assist support staff in delivery of patient care.
Participate in monthly in-services.
Assist Admissions Supervisor with clinical authorizations.
Communicate effectively with insurance providers.
Maintain a clean, organized work environment.
Maintain professionalism with staff members and clients at all times.
Maintain privacy of patients by protecting health information protected under HIPAA.
Make rounds with nursing staff during visits; and
Perform other duties as assigned.
Required Qualifications and Skills
Master’s degree in a Counseling, social work, psychology and another helping profession
Familiar with ASAM (American Society of Addiction Medicine) criteria
At least 1 year of case management experience
6 months substance abuse treatment experience
Proficient in MS Office 365 Suite
Excellent written and verbal communication skills
Preferred
1 year of Electronic Health Record and Practice Management experience
2 plus years of substance use disorder utilization review experience
Familiarity with ASAM criteria, substance abuse treatment, and HIPAA
Excellent comprehension and analytical skills
Excellent customer service skills
Compensation And Benefits Competitive compensation and benefits package includes insurance (health, dental, vision, life, long-term and short-term disability), leave benefits and 401k match.
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Medical Practices, Hospitals and Health Care, and Veterinary Services
#J-18808-Ljbffr