Utilization Review Specialist
About the role
Tully Hill Treatment and Recovery is a nationally recognized treatment facility dedicated to helping individuals overcome substance use disorder. The Utilization Review Specialist plays a crucial role in ensuring that patients receive appropriate and timely coverage from insurance companies.
Responsibilities
- Provide clinical and medical information to insurance companies and third party payers to justify initial admission and continued stay coverage and prevent denial of payment.
- Research and communicate insurance companies' treatment requirements to the treatment team.
- Facilitate appeals of patient claims.
- Cross-train to assist in conducting the pre-admission and admission processes by interviewing, screening, and evaluating potential patients, obtaining treatment authorization, communicating patient financial responsibilities, and documenting pertinent patient information into the electronic medical record.
- Review medical records for completeness of necessary clinical, nursing, and medical information and communicate deficiencies to the treatment team.
Requirements
- Ability to work in a fast-paced environment as part of a multidisciplinary team.
- Strong written and verbal communication skills.
- Competency in an electronic medical record and good computer skills.
- Current RN or LPN licensure or other NYS QHP certification.
- Ensure quality, timeliness, and accuracy of documentation to ensure compliance with CARF standards, NYS OASAS regulations, other applicable State and Federal regulations, referral partners, and insurance contract and reimbursement requirements.
- Demonstrable knowledge of substance use disorder and 12-step philosophy and commercial health insurance.
- Previous utilization review / managed care work experience a plus.
Qualifications
- High school diploma or equivalent.
- Current RN or LPN licensure or other NYS QHP certification.
- Experience in healthcare administration or related field.
- Knowledge of substance use disorder and 12-step philosophy.
- Experience with electronic medical records and familiarity with relevant regulations.
Skills
- Strong written and verbal communication skills.
- Proficiency in an electronic medical record system.
- Ability to work in a fast-paced environment.
- Knowledge of substance use disorder and 12-step philosophy.
- Experience with managed care and utilization review.
Benefits
Tully Hill Treatment and Recovery offers a comprehensive benefits package including health insurance, 401(k) plan, vacation, sick and personal time, paid holidays, company-paid short-term disability insurance, voluntary dental insurance, voluntary additional disability insurance, and voluntary life insurance.
Pay
The salary range is $27.00-38.00 per hour, commensurate with experience and education/credentials. This range is provided in accordance with NYS law and is based on Tully Hill's good faith belief of what is accurate at the time of posting. Tully Hill considers factors including, but not limited to, the position and associated responsibilities, market and business considerations, as well as the candidate's education/training, credentials, and work experience.
Schedule
Hours are flexible to accommodate the needs of the team and the patients.
Contact Information
To apply, please download and send a completed Application, Resume, and Salary Requirements to:
- Email: resumes@tullyhill.com
- Fax: 315-413-5105
- Mailing address: Tully Hill Corporation
Attn: Human Resources
PO Box 1116
Tully, NY 13159