Job description
Enlightened Solutions – UTILIZATION REVIEW SPECIALIST
This is a part-time remote position for an addiction recovery center.
Experience:
This part-time, remote position will serve established substance abuse treatment and detox businesses that are expanding. The ideal candidate would have significant knowledge of ASAM criteria and proven success with utilization review for partial care and intensive outpatient treatment.
Responsibilities
- Knowledge of chemical dependency diagnosis and treatment process.
- Completes Initial, concurrent, Peer Reviews, Expedited Appeal Reviews, and retrospective reviews in a timely manner to ensure continuous coverage.
- Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
- Review and monitor utilization for members and plans and implements solutions that directly influence quality of care and financial liability based on the needs of the member.
- Collaborate with treatment team to discuss clinical authorization and quality of care.
- Participates in clinical meetings, observation and interaction with clients to support concurrent reviews.
- Consistent and timely response to emails and other communications relating to utilization review.
- Prepare and submit Appeals.
- Other tasks or duties as assigned.