Tully Hill Treatment & Recovery
Utilization Review Specialist
Tully Hill Treatment & Recovery, Tully, New York, United States
Join to apply for the
Utilization Review Specialist
role at
Tully Hill Treatment & Recovery
Do you have a passion for helping others?
Tully Hill Treatment and Recovery
is dedicated to the belief that substance use disorder is a disease – chronic, progressive and above all, treatable. Join the multidisciplinary team of professionals committed to helping patients and families live sober, productive, happy lives, free of addiction and its aftermath. We provide challenging and rewarding work for those with the skills and aptitude to work with individuals in their most vulnerable condition.
Responsibilities
Provide clinical and medical information to insurance companies and third‑party payers to justify initial admission and continued stay coverage and prevent denial of payment.
Research and communicate insurance companies’ treatment requirements to the treatment team.
Facilitate appeals of patient claims and coordinate with the multidisciplinary team to ensure appropriate level of care via treatment and care documentation that meets payers’ criteria.
Review medical records for completeness of necessary clinical, nursing, and medical information and communicate deficiencies to the treatment team.
Assist in conducting pre‑admission and admission processes by interviewing, screening, evaluating potential patients, obtaining treatment authorization, communicating patient financial responsibilities, and documenting pertinent information into the electronic medical record.
Qualifications
Ability to work in a fast‑paced environment as part of a multidiciplinary team.
Strong written and verbal communication skills.
Competency in an electronic medical record and good computer skills.
Current RN, LPN licensure or other NYS QHP certification required.
Ensure quality, timeliness, and accuracy of documentation to ensure compliance with CARF standards, NYS OASAS regulations, other applicable State and Federal regulations, referral partners, and insurance contract and reimbursement requirements.
Demonstrable knowledge of substance use disorder and 12‑step philosophy and commercial health insurance preferred.
Previous utilization review / managed care work experience a plus.
Senior level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Other
Industries:
Hospitals and Health Care
Location:
Syracuse, NY – with a beautiful well maintained property on 33 acres in the Tully Valley, just 15‑20 minutes south of Syracuse.
Salary Range –
$27.00–$38.00 per hour
Benefits
Health insurance
401(k) plan
Vacation, sick and personal time
Paid holidays
Company‑paid short‑term disability insurance
Voluntary dental insurance
Voluntary additional disability insurance
Voluntary life insurance
Tully Hill Treatment and Recovery is a 501(c)(3) not‑for‑profit corporation, mission driven and following a business model. Pay rate is commensurate with experience and education/credentials. Comprehensive benefits package included.
Salary range provided in accordance with NYS law, based on Tully Hill’s good faith belief at the time of posting. Factors considered include the position and associated responsibilities, market and business considerations, candidate’s education/training, credentials, and work experience.
#J-18808-Ljbffr
Utilization Review Specialist
role at
Tully Hill Treatment & Recovery
Do you have a passion for helping others?
Tully Hill Treatment and Recovery
is dedicated to the belief that substance use disorder is a disease – chronic, progressive and above all, treatable. Join the multidisciplinary team of professionals committed to helping patients and families live sober, productive, happy lives, free of addiction and its aftermath. We provide challenging and rewarding work for those with the skills and aptitude to work with individuals in their most vulnerable condition.
Responsibilities
Provide clinical and medical information to insurance companies and third‑party payers to justify initial admission and continued stay coverage and prevent denial of payment.
Research and communicate insurance companies’ treatment requirements to the treatment team.
Facilitate appeals of patient claims and coordinate with the multidisciplinary team to ensure appropriate level of care via treatment and care documentation that meets payers’ criteria.
Review medical records for completeness of necessary clinical, nursing, and medical information and communicate deficiencies to the treatment team.
Assist in conducting pre‑admission and admission processes by interviewing, screening, evaluating potential patients, obtaining treatment authorization, communicating patient financial responsibilities, and documenting pertinent information into the electronic medical record.
Qualifications
Ability to work in a fast‑paced environment as part of a multidiciplinary team.
Strong written and verbal communication skills.
Competency in an electronic medical record and good computer skills.
Current RN, LPN licensure or other NYS QHP certification required.
Ensure quality, timeliness, and accuracy of documentation to ensure compliance with CARF standards, NYS OASAS regulations, other applicable State and Federal regulations, referral partners, and insurance contract and reimbursement requirements.
Demonstrable knowledge of substance use disorder and 12‑step philosophy and commercial health insurance preferred.
Previous utilization review / managed care work experience a plus.
Senior level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Other
Industries:
Hospitals and Health Care
Location:
Syracuse, NY – with a beautiful well maintained property on 33 acres in the Tully Valley, just 15‑20 minutes south of Syracuse.
Salary Range –
$27.00–$38.00 per hour
Benefits
Health insurance
401(k) plan
Vacation, sick and personal time
Paid holidays
Company‑paid short‑term disability insurance
Voluntary dental insurance
Voluntary additional disability insurance
Voluntary life insurance
Tully Hill Treatment and Recovery is a 501(c)(3) not‑for‑profit corporation, mission driven and following a business model. Pay rate is commensurate with experience and education/credentials. Comprehensive benefits package included.
Salary range provided in accordance with NYS law, based on Tully Hill’s good faith belief at the time of posting. Factors considered include the position and associated responsibilities, market and business considerations, candidate’s education/training, credentials, and work experience.
#J-18808-Ljbffr