Title:Utilization Review Counselor ID:5712 Department:Utilization Review Location:Westhampton Beach Description Full-Time Opportunity Available + Schedule:Monday - Friday + Hours:40-hour week + Pay:$25.00 - $30.00/hr Benefits Available for Full-Time Employees: + Generous Paid Time Off Policy + Medical, Dental, and Vision Insurance + Flexible Spending Account + Basic Group Life AD&D Insurance (No Cost) + Voluntary Life Insurance + Other Voluntary Benefits + Reimbursement for Professional Development Expenses + Employee Assistance Program + Retirement Program (401k) + 8 Paid Holidays MAIN FUNCTION: + Review appropriateness and clinical necessity of admissions, continued stays, and discharges + Maintain contact for insurance approval reviews + Assigned user role(s) and information systems access as needed + Classified as Essential Day 2 for emergency closures ESSENTIAL DUTIES AND RESPONSIBILITIES: + Review patient EMR for admission, continued stay, and discharge criteria + Perform telephone reviews with insurance companies/agencies and document in EMR + Coordinate with departments (Medical, Nursing, Billing, etc.) for needed information + Regularly update administration on UR Department status + Obtain and review information for insurance appeal processes + Ensure patient confidentiality and complete medical records for requested information + Alert staff when additional documentation is needed and inform Medical Records + Provide input at Clinical Exchange and Case Conference Meetings + Inservice staff as needed + Obtain precertifications for outpatient treatment and provide info to Outpatient Facilities + Generate and distribute daily certification report + Perform other duties as assigned COMPETENCY REQUIREMENTS: + Knowledge of Managed Care + Clinical knowledge + Strong communication skills + EMR documentation proficiency + Skilled in computer use, including EMR, Microsoft Outlook, and other systems EDUCATION AND QUALIFICATIONS: + Clinical experience in alcohol and substance abuse preferred + Certifications: CASAC, CASAC-T, CCDN, CARN, LPN, RN + Knowledge of medical records + Ability to manage heavy telephone workload + Strong communication and organizational skills PHYSICAL DEMANDS: + Must be able to talk and hear + Requires close and distance vision, and focus adjustment + Primarily sedentary, with occasional walking and standing + Ability to use computer, keyboard, mouse, calculator, copier, fax, scanner, and telephone