Utilization Reviewer (25-19)
Pathfinder, Inc. - Little Rock, AR

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DESCRIPTION

The Utilization Reviewer is responsible for ensuring the timely and accurate completion, submission, and tracking of prior authorization continuing stay reviews; quality control of care and documentation, report building, and file maintenance. Responsible for compliance review of unit utilization pertaining mental health clinical services.

1 Full-time position is available.

Hours: Mon-Fri, 8-4:30.

Location: Little Rock, AR.

DUTIES

Responsible for the compilation of information necessary for the accurate completion of all prior authorization forms and reviews on a consistent basis.

Will receive information from Mental Health Professionals/Therapists providing services and accurately completes all required documents.

Produce reports as required for Director regarding the status and tracking of authorization approvals and/or denials.

Responsible for the organized maintenance and tracking system for all Prior Authorizations, Unit extensions or requests for additional units as required for utilization; and to prevent errors and omissions resulting in financial loss to Pathfinder, Inc., or, resulting in adverse audit findings.

Interfacing as needed with Mental Health Professionals/Therapists for all clinical matters relevant to the completion, accuracy, and submission of the required documents.

Responsible for verification of Prior Authorization Reviews, and related, to ensure no omissions.

Performs Quality Assurance reviews as time requires, secondary to the primary duties described herein.

Prepares other reports as required.

All duties performed on site.

Responsible for entering submissions and/or reviews on computer as required.

Responsible for handling Medicaid/Other insurance denials and requests for additional information, relevant to the accurate submission of prior authorization continuing stay reviews.

Must possess good human relations skills.

Responsible for participation in appropriate in-service or external education including review of various insurance changes, filing claims of Medicare, Medicaid, authorized Medicaid managed care agency, or other insurances.

Responsible for acting as the primary interface and contact with the insurance companies, by phone, mail, or in person.

Responsible for consistent reporting to the Director on all Prior Authorization or Utilization matters.

Job duties must be performed at work location as assigned by Supervisor.

QUALIFICATIONS

Bachelor's degree in Human Services field (Psychology, Social Work, etc.); or 3-5 years experience in reviewing and preparing DD/human services documents related to eligibility determination, applications and provisions of services; and/or equivalent combination of education and job experience; or 3-5 years of degree nursing experience, plus 2 years experience supervising staff.

Responsible for the compilation of information necessary for the accurate completion of all prior authorization forms and reviews on a consistent basis.

Will receive information from Mental Health Professionals/Therapists providing services and accurately completes all required documents.

Produce reports as required for Director regarding the status and tracking of authorization approvals and/or denials.

Responsible for the organized maintenance and tracking system for all Prior Authorizations, Unit extensions or requests for additional units as required for utilization; and to prevent errors and omissions resulting in financial loss to Pathfinder, Inc., or, resulting in adverse audit findings.

Interfacing as needed with Mental Health Professionals/Therapists for all clinical matters relevant to the completion, accuracy, and submission of the required documents.

Responsible for verification of Prior Authorization Reviews, and related, to ensure no omissions.

Performs Quality Assurance reviews as time requires, secondary to the primary duties described herein.

Prepares other reports as required.

All duties performed on site.

Responsible for entering submissions and/or reviews on computer as required.

Responsible for handling Medicaid/Other insurance denials and requests for additional information, relevant to the accurate submission of prior authorization continuing stay reviews.

Must possess good human relations skills.

Responsible for participation in appropriate in-service or external education including review of various insurance changes, filing claims of Medicare, Medicaid, authorized Medicaid managed care agency, or other insurances.

Responsible for acting as the primary interface and contact with the insurance companies, by phone, mail, or in person.

Responsible for consistent reporting to the Director on all Prior Authorization or Utilization matters.

Job duties must be performed at work location as assigned by Supervisor.