Steps Recovery Center LLC

Steps Recovery Center LLC is hiring: Utilization Review Specialist in Orem

Steps Recovery Center LLC, Orem, UT, United States

Job Description

Position Summary

We are looking to add a great person to work as our Utilization Review Specialist at Steps Recovery Center. The Utilization Specialist is vital in ensuring that the treatment center operates efficiently, patients receive necessary care, and the organization maintains financial stability through effective insurance management. Our UR specialist will review activities for all levels of behavioral health care, including inpatient, residential, partial hospitalization, intensive outpatient and outpatient authorization requests with contacts to facilities and providers as needed to accomplish this task.

Steps Recovery Center is looking for an energetic, task oriented UR specialist to join our team full time at our Orem, Utah location.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:
Maintains UR information and retrieves data for reports, as needed.
Establishes and maintains rapport with clinical staff to ensure adequate, accurate documentation of patient’s care.
Communicates results of third party reviews to appropriate staff for length of stay coordination and discharge planning.
Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
Participate in treatment plan reviews, when required.
Coordinates appeals of third party denials.
Assists with monitoring documentation in medical records for compliance with contracts, state and federal requirements and process improvement activities.
Coordinates with other departments and staff to maintain patient confidentiality (Record Management).
Participates in on-going training to stay current on processes and procedures.
Adheres to the policies and procedures for Utilization Management activities as well as screening, triage and referral activities, including timeliness of activities/services and accuracy of documentation.
Completes Continuing Care authorizations under the supervision of the UR Manager.
Performs other related duties as required and assigned.

Qualifications (Knowledge, Skills, and Abilities)

Bachelor’s degree in Nursing, Social Work, or a related healthcare field (Master’s preferred).
2-4 years of experience in utilization review, case management, or a related field, preferably within a behavioral health or addiction treatment setting.
In-depth knowledge of healthcare and insurance systems, including prior authorization and medical necessity criteria.
Strong communication and organizational skills.
Experience with electronic health records (EHR) and utilization review software.
Familiarity with Medicaid, Medicare, and commercial insurance payer guidelines.

**Preferred Qualifications**

Certification in Utilization Review (CPUR) or Case Management (CCM).
Experience working with behavioral health and substance use treatment populations.

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