Job description
We save lives while providing the opportunity for people to realize their healthy selves.:
We now seek a Utilization Review Coordinator to join our treatment team at Monte Nido Rain Rock Monte Nido’s trusted treatment approach focuses on the restoration of physiological and nutritional balance, implementation of healthy eating and exercise routines, elimination of harmful behaviors, and development of motivation and treatment engagement.
The on-site Utilization Review Coordinator is responsible for conducting all URs, peer reviews, and pre-certifications, documenting these reviews, and coordinating with both the on-site clinical team, admissions, verifications, and billing regarding clients’ insurance status. Responsibilities Include::
We offer an excellent benefits package that includes paid time off, 401(k) retirement plan, company-paid life and disability insurance, great medical and dental plan choices, vision, and many other insurance options to meet you own and your family's needs.
#LI-montenidocareers
For more than 25 years,
Monte Nido & Affiliates has been delivering proven treatment for eating disorders. Our model of treatment blends the personalized and medically sophisticated care for which we are known with the latest research and strategies for those overcoming eating disorders. Our treatment setting is intimate with a high staff-to-client ratio, and an emphasis on individual therapy and highly individualized treatment.
In a recent survey, over 84% of our employees were “satisfied” or “very satisfied” working at Monte Nido & Affiliates!
We now seek a Utilization Review Coordinator to join our treatment team at Monte Nido Rain Rock Monte Nido’s trusted treatment approach focuses on the restoration of physiological and nutritional balance, implementation of healthy eating and exercise routines, elimination of harmful behaviors, and development of motivation and treatment engagement.
The on-site Utilization Review Coordinator is responsible for conducting all URs, peer reviews, and pre-certifications, documenting these reviews, and coordinating with both the on-site clinical team, admissions, verifications, and billing regarding clients’ insurance status.
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Conduct all utilization reviews and peer reviews as needed and appropriately document following company protocols.
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Obtain information from clinical staff as needed to conduct utilization reviews, peer reviews, pre-certifications, and argue single case agreements.
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Communicate with clinical staff regarding status of client authorization.
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Communicate with billing regarding billing/claims issues and status of single case agreements as needed.
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Communicate with admissions regarding status of client authorization, potential denials, and potential for private payment.
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Conduct pre-authorizations for clients changing level of care.
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Follow standardized clinical documentation across programs.
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Writing letters of appeal for denials.
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Communicate emerging trends with insurance companies to clinical director.
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Maintain database of on insurance company clinical care guidelines, APA guidelines, medical necessity criteria and other necessary documents and clinical ammunition to support UR process.
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Keep up to date on insurance expectations/changes annually.
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Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff diversity.
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Seek corrective criticism and evaluate suggestions objectively.
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Maintain acceptable overall attendance.
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Promote a favorable/positive work atmosphere.
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Attend in-services and educational training as necessary and as assigned.
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Seek out learning experiences and incorporate new knowledge into practice.
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Maintain flexibility and adaptability to expected and unexpected changes in the work environment.
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Report incidents, accidents, and occurrences in accordance with policies and procedures.
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Maintain safety of the physical environment.
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Comply with facility policies and procedures
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Master’s Degree in Psychology, Social Work, Nursing, or mental health-related field required
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At least one year of experience relating to insurance authorizations and managed care
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Licensed behavioral health clinician/provider preferred
We offer an excellent benefits package that includes paid time off, 401(k) retirement plan, company-paid life and disability insurance, great medical and dental plan choices, vision, and many other insurance options to meet you own and your family's needs.
#LI-montenidocareers
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