Utilization Reviewer
The Emily Program 4 reviews - Saint Paul, MN

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The Utilization Reviewer will be responsible for filling 26 residential beds across two locations. This position will maximize residential treatment center (RTC) benefits, length of stay, etc. in order to get clients needing RTC the treatment they need, when they need it, and for as long as they need it.

  • Aggressively secure RTC benefits for incoming and continuing residents
  • Work with admission coordinator to put together prior authorizations
  • Call in and persistently follow up on all RTC prior authorizations
  • Work with billing department on verifying benefits and continued follow up on any billing or insurance issues
  • Maintain productive relationships with insurance companies, case management staff, etc.
  • Schedule and complete all concurrent clinical reviews for RTC clients
    • Call/e-mail RTC providers to coordinate information needed for all concurrent reviews
    • Prepare providers and staff so that they are aggressively ‘making a case’ for a clients’ admission or ongoing RTC stay
    • Manage the review process- give feedback to staff, stay ‘on message’, etc.
  • Attend case management at both facilities to get needed information and communicate about insurance cases for RTC clients
  • Secure authorizations for clients attending aftercare programs within TEP
  • Schedule and communicate about all peer-to-peer reviews with insurance companies and RTC providers
  • Work with legal on any appeals
  • Attend length of stay meetings which occur one week after resident admits
  • Bachelor’s degree required.
  • Master’s degree preferred; ideally with one of the following – (LGSW, MSW, LCSW, LAMFT, LPC)
  • Minimum of one year of experience doing utilization in a healthcare setting is required; experience doing utilization for mental health agency is preferred
  • Previous experience working in an inpatient or residential setting strongly preferred
  • Minimum of one year of direct care experience is preferred
  • Ability to inform and persuade various audiences, including internal and external groups
  • Excellent organizational skills, attention to detail and ability to efficiently follow through with tasks
  • Effective communication skills with a variety of people in multiple settings
  • Ability to see big picture and handle the day-to-day logistics of the role
  • Ability to multi-task and prioritize based on facility needs
  • Clear understanding and ability to apply of DSM-IV-TR, medical terminology, and mental health terminology
To Apply: Please upload cover letter and resume in one document and apply online .

The position is open until filled. The Emily Program is an Equal Opportunity Employer (EOE).

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