Utilization Review Specialist

Sunshine Behavioral Health• WA, US, WA

5d•$55,000 - $65,000•Onsite

About The Position

The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

Requirements

Proficiency in Excel, Word and electronic charting.
Ability to multi-task.
Ability to work with minimal supervision.
Basic knowledge of HIPAA.
Excellent customer service skills.
Ability to work under pressure.
Problem Solving – Ability to identify and resolve problems in efficient and effective ways.
Ethics – Treat clients, staff, co-workers, visitors, contractors, and guests of Sunshine Behavioral Health with respect and dignity; work ethically and uphold the values and standards of Sunshine Behavioral Health.
Attendance, Punctuality, Reliability – Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are covered in the event of an absence or scheduled vacation.
Leadership – Constant development of staff, co-workers and clients, in effort to achieve each individual's highest potential.
Strong Character – Staying calm under pressure is essential. Having an approachable demeanor without compromising Sunshine Behavioral Health Standards of ethics and workmanship.
Flexibility– Openness to different and new ways of doing things; willingness to modify one's preferred way of doing things.
Organization – Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them.
A minimum of two years of experience with Utilization Review.
Excellent customer service skills.
Valid Driver’s License.

Nice To Haves

College degree preferred.

Responsibilities

Complete assessments and pre-certifications for clients.
Communicate necessary information received to appropriate staff in a timely and efficient matter.
Demonstrate understanding of medical terminology.
Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
Demonstrate knowledge of EOB interpretation.
Daily use of ten key, data entry and spreadsheets applications.
Communicate effectively with peers and supervisor to address billing and claim issues.
Follow all HIPAA, compliance, privacy and confidentiality standards.
Participate in development of Quality Improvement projects.
Follow all practices detailed in the companies Policies and Procedures Manual and Employee Handbook.
Attend and participate in staff meetings and trainings.
Demonstrate expertise in Psychiatric and Addiction Disorders.
Engage in appropriate written and verbal communication with families, insurance companies and other professionals.
Demonstrate ability to work with Excel, Word and electronic charting.
Ability to work with minimal supervision.
Organized and detail oriented.
Other duties as assigned.