Immediate Supervisor
UR Manager
JOB PURPOSE: The Utilization Review Specialist is responsible for managing an active caseload of clients for the following levels of care: Detox, Residential, Partial Hospitalization, and Intensive Outpatient. S/he acts as a liaison between insurance companies, the client, and the Clinical Team. The review specialist is primarily responsible for ensuring that every client at Windward Way Recovery is authorized by insurance at the appropriate level of coverage as applicable
A.
Job Duties and Responsibilities
1. Follow Zinnia Health LLC policies and procedures.
2. Updating excel spreadsheets accordingly when authorizations are obtained
3. Conduct initial, concurrent, and discharge reviews to optimize benefits and utilization. This includes leaving voicemails, completing live reviews, and submitting ITR's
4. Utilize clinical documentation and critical thinking to obtain the maximum amount of time authorized in substance abuse and mental health treatment for all levels of care.
5. Documenting notes for reviews in EMR
6. Assist in scheduling peer reviews in a timely manner to ensure continuous coverage.
7. Completing Retrospective reviews which includes contacting the insurance carriers, collecting clinical, and faxing to the appropriate department.
8. Communicate with UR manager any issues as they arise, missing documentation, and Low medical necessity cases.
9. Update KIPU and send authorization/step down emails to appropriate people.
B
Expectations
1. DEPENDABILITY - Employee can be counted on to complete assigned tasks in a timely manner with little supervision. Accepts responsibility when necessary to see that the job gets done.
2. ATTENDANCE AND PUNCTUALITY - Is prompt and on time for work, assignments and meetings. Notifies supervisor prior to lateness or absence. Understands that excess absences pose a hardship on other employees.
3. JOB SKILLS AND KNOWLEDGE - Employee completes all chart related documents and correspondence for assigned clients in a timely manner.
4. Employee works cooperatively with other community resources and referral sources to coordinate services to clients.
5. QUANTITY AND QUALITY OF WORK – Cares about the quality and accuracy of work being produced. Accepts responsibility for completing job tasks. Uses time productively and efficiently.
6. ATTITUDE – Demonstrates a cooperative, positive, and enthusiastic attitude toward fellow employees, clients and visitors. Maintains a positive attitude in carrying out assignments and is helpful and courteous to fellow employees.
7. CONFIDENTIALITY - Know and follows confidentiality law and procedures at all times.
8. COMMUNICATION SKILLS-Is effective in written and oral expression. Demonstrates proper telephone etiquette and able to communicate easily with clients, referral sources, and visitors in an appropriate manner. Relates to clients and co-workers in a respectful and professional manner.
9. CONDUCT – Conducts one’s self in a manner consistent with the agency’s code of ethics and code of conduct. Shows professionalism in office setting.
10. FLEXIBILITY / HANDLING EMERGENCIES – Responds well to changing situations or routines. Handles crisis situation calmly and professionally.
C.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies to perform the essential functions of this position.
· Analytical—the individual synthesizes complex or diverse information.
· Problem solving—the individual identifies and resolves problems in a timely manner and gathers and analyzes information skillfully.
· Oral communication—the individual speaks clearly and persuasively in positive or negative situations, demonstrates group presentation skills and conducts productive meetings
· Delegation—the individual delegates work assignments, gives authority to work independently, sets expectations and monitors delegated activities.
· Leadership—the individual inspires and motivates others to perform well and accepts feedback from others.
· Quality management—the individual looks for ways to improve and promote quality and demonstrates accuracy and thoroughness.
· Judgment - the individual displays willingness to make decisions, exhibits sound and accurate judgment, and makes timely decisions.
· Planning/organizing—the individual prioritizes and plans work activities, uses time efficiently and develops realistic action plans.
· Safety and security—the individual observes safety and security procedures and uses equipment and materials properly.
D.
Minimum Qualifications
Education / Experience
· Minimum of 1 year of experience in the field
· Experience in managing self- administration of medication.
Certificates and Licenses
· No certificate or license required
Knowledge
· A knowledge of regulations concerning alcoholism and drug addiction treatment.
· Working knowledge of alcoholism and drug addiction and treatment procedures for such illness.
E.
Work Environment Characteristics
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Noise Level – usually quiet
· Physical Demands – employee is frequently required to sit; employee must occasionally lift and / or move up to 25 pounds
I have reviewed and discussed this performance evaluation with my supervisor. I am aware that I have an opportunity to comment on this performance evaluation in writing and that my comments will become part of the performance evaluation. I am aware this will be maintained in my personnel file.
Job Type: Full-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
Work Location: In person