Utilization Review Assistant

ESSENTIAL FUNCTIONS:

• Perform pre-certification and negotiate continued stay with third party payers.
• Gather data to support case management activities, including presentation of gathered data and case notes.
• Coordinate discharge planning with clinical team, maintain CRM database with discharge information and follow up.
• Present case information and the needs of third-party payers.
• Assist in admissions review, concurrent reviews and discharge planning.
• Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.
• Informs management about the status of current patients; documents utilization activities as instructed. Participates in performance improvement activities.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• High school diploma or equivalent required.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.