Utilization Review and Quality Specialist

River’s Bend is a growing Outpatient Mental Health and Substance Use therapy practice which provides the most innovative, evidence-based outpatient behavioral healthcare to all our clients and their families including: Individual, Intensive Outpatient (IOP) and Partial Hospitalization (PHP) levels of care available.  Our clinical team provides professional, comprehensive, state-of-the-art mental health and chemical dependency treatment in a respectful and dignified manner. We have been awarded Blue Distinction with Blue Cross Blue Shield and maintain behavioral health Joint Commission accreditation. We have an integrated electronic health record system that supports all of our clinical services and offer a hybrid model for outpatient therapy.

River’s Bend is seeking a Utilization Review and Quality Specialist to join our growing team of innovative professionals at our West Bloomfield, Michigan location. The Utilization and Quality Specialist is responsible for organizing and obtaining insurance authorizations, providing required clinical documentation and support of level of care, and auditing of clinical charts for completion, and content.

Required Qualifications:

• Master's in behavioral health field
• Independent License: LMSW, LLMSW, LP, LLP, LPC, LLPC

Major Responsibilities:

• Strong advocacy and persistence working with insurance companies to obtain and maintain authorization from insurance companies for outpatient sessions, Partial Hospitalization (PHP) sessions, and Intensive Outpatient (IOP) sessions
  
• Audit clinical charts for completion and content 
• Track and report data related to authorizations and chart audits to Compliance Manager
• Support with credentialing process with insurance companies
• Provide support to Compliance Manager and Clinical Director as directed
• Other duties as assigned 
• Excellent attention to detail, communication, and organization skills
  
• Ability to utilize electronic health record system (EHR), Zoom and Microsoft Office
  

Preferred but not required:

• Previous experience with utilization review, clinical audits and/or insurance verifications

Benefits:

• 401(k) and Employer Match
  
• Health, Dental, and Vision Insurance
• Professional liability/Malpractice insurance paid in full by River’s Bend
• $500 Annual Reimbursement Allowance: Available for reimbursement for CEUs, Certifications, License Renewals, etc. (that are applicable to the work at River’s Bend)
• Paid time off
  

Schedule: Monday to Friday in person at West Bloomfield office

Job Type: Full-time/Exempt salary

Salary:  $62,000-$65,000