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Utilization Review Specialist

Job Code: 1125
Posting Title: Utilization Review Specialist
Shift: Day
Department: Accounts Receivable
Scheduled Days: Monday, Tuesday, Wednesday, Thursday, Friday
Employment Type: full-time
Location: Lipan - Main Office

Description

Arapahoe House is currently seeking a Utilization Review Specialist to join our Accounts Receivable team.
 
This Full-time position works 7:00am to 4:00pm Monday through Friday at our Thornton location. The Utilization Review Specialist independently manages and performs clinical authorizations for clients admitted to Arapahoe House in various levels of care, through continuous coordination with clinical staff and medical utilization/care management personnel of multiple health plans by performing the following duties.
 
Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
-        Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load
-        Responsible for ensuring effectiveness of medically necessary, covered, quality services at the least restrictive level of care within a coordinated care delivery system for Arapahoe House clients
-        Ensures integration of care and effective utilization of resources through review of documentation, discussion with providers and clients, and application of clinical guidelines as applicable to the level of care.
-        Discusses benefits information with clients as necessary
-        Conducts concurrent reviews to ensure medical necessity for continued utilization
-        Liaisons with the treatment provider regarding the identified treatment plan in accordance with concurrent review criteria
-        Assists the treatment provider in identifying and coordinating alternative, least restrictive settings that will provide appropriate and qualitative care while controlling cost
-        Coordinates services with medical utilization/care management personnel of multiple health plans to ensure appropriate, cost effective treatment and identify areas where both utilization management personnel can collaborate
-        Assists with the collection and analysis of utilization data and tracks ongoing care management cases and their outcomes
-        Serves as a liaison for the client and Arapahoe House with insurance companies
-        Negotiates and advocates for patient length of stay and level of care
-        Oversees utilization review activities with identified departments to ensure reimbursement for services provided by the organization
-        Acts professionally in all interactions with providers, colleagues, and external contacts            
 
Qualifications: The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform this job.
Education/Experience:
-        Clinical Master’s degree in psychology, counseling or social work
-        Experience in working with both adult and adolescent substance abuse populations
-        Working knowledge of American Society of Addiction Medicine (ASAM) criteria for level of care placement
-        Working knowledge of behavioral health diagnostic symptoms (e.g. DSM-IV-R, ICD9)
Certificates and Licenses:
-        Certified Addiction Counselor II (CAC II) or equivalent combination of education and experience to a CAC II.
-        Current licensure in the State of Colorado as an LPC, LAC, LMFT or LCSW or License eligible within 6 months.
-        Valid Colorado Driver's License
-        Current registration in the State of Colorado DORA database as one of the following approved Addiction Counselor designations: Registered Psychotherapist, Certified Addiction Counselor, or mental health licensure (LAC, LPC, LMFT, LSW or LCSW) is required.
Language Ability:
-        Ability to read and interpret common reports and documents as well as respond to common inquiries or complaints.
-        Ability to read, analyze, and interpret journals, financial reports, and legal documents.
-        Ability to write clinical notes and summaries in prescribed style and format.
-        Ability to communicate in both Spanish and English is preferred.
Math Ability:
-        Intermediate mathematical skills - ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; compute rate, ratio, and percent; apply concepts of basic algebra and geometry.
Reasoning Ability:
-        Ability to define problems, collect data, establish facts, and draw valid conclusions.
-        Ability to interpret a variety of instructions and deal with abstract and concrete variables.
Computer Skills:
-        To perform this job successfully, an individual should be proficient in Microsoft Word, Microsoft Excel and Microsoft Outlook.
-        Familiarity with Electronic Health Records preferred.
 
Work Environment: 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.
-        The noise level in the work environment is usually quiet but can become louder at times due to group discussions or activities.
-        This position may require travel between Arapahoe House locations and to outside agencies with varying work environments.
-        Arapahoe House is a tobacco-free environment.
 
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
-        The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
-        Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
-        While performing the duties of this Job, the employee is regularly required to talk or hear.
-        The employee is frequently required to stand and walk.
-        The employee is occasionally required to sit and use a computer and/or reach with hands and arms.
 
Arapahoe House is an equal opportunity employer.

  





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