Behavioral Healthcare Utilization Review Spec

Horizon Behavioral Health•Lynchburg, VA

9d•Onsite

About The Position

The Behavioral Healthcare Utilization Review Specialist works on-site, and will proactively monitor utilization of services for clients, reviewing for quality of services and medical necessity. The employee will review clients’ medical records to ensure appropriate utilization of treatment resources, medical necessity, proper documentation, and compliance with federal and state regulations, and certification requirements of insurance plans or other managed care organizations (MCOs). This position will report to the CQI Manager.

Requirements

Bachelor's degree from an accredited college/university in an applicable human services field.
Two years of continuous quality improvement and/or utilization review experience.
Proficiency in MS Office software and EMR systems.
Ability to extract and analyze data.
Ability to develop and present statistical and narrative reports.
Must be proficient in MS Office software and EMR systems.
Able to collaborate with all members of clinical team/medical providers.
Excellent verbal and written communication skills.
Ability to work independently as well as with a team.
Excellent organizational and time management skills.
Willing and available to work modified schedules (weekends, holiday, etc.) as required.
Ability to drive and must possess a valid driver's license.

Nice To Haves

Master’s degree in social work, Mental Health Counseling, or related health field preferred.
At least one year of managed care experience.
Behavioral Health experience is desirable.
An equivalent combination of education and experience that provides the candidate with the required knowledge, skills and abilities may be considered.
Knowledge of behavioral healthcare terminology, the course and progress of substance abuse treatment and medical terminology.
Knowledge of Medicaid and MCO regulations and policies, relevant to behavioral healthcare and substance use.
Knowledge of Utilization Review protocols and auditing skills.
Knowledge of DSM 5, CPT Codes and ICD 10.
Knowledge of levels of care and medical necessity.
Ability to review and understand medical records, treatment plans and progress notes.

Responsibilities

Proactively monitor utilization of services for clients, reviewing for quality of services and medical necessity.
Review clients’ medical records to ensure appropriate utilization of treatment resources, medical necessity, proper documentation, and compliance with federal and state regulations, and certification requirements of insurance plans or other managed care organizations (MCOs).