Utilization Review

Description:

POSITION SUMMARY:

The Utilization Review Support position performs various clinical and clerical duties in support of the Community Support Clinicians (CSC) working in WISE. This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.

 DUTIES AND RESPONSIBILITIES:

  • With clinical oversight, processes prior authorization requests for CSCs in order to generate an authorization to credentialed providers for services requested. . Acts as a liaison between CSC, MFP, DSS and providers These tasks will be executed in a manner that is both rapid and reflective of efforts to avoid errors;
  • Assists CSCs in creating/updating changes in recovery plan and cost sheet to reflect current usage by client.  Update information in necessary database and with Home Health Care Providers. Acts as a liaison with Beacon Health Options and CHN.
  • Provides telephone support to the CSCs, to ensure prompt, live responses to Providers requesting assistance with executing tasks associated with the WISE Recovery Plan. This includes, but is not limited to, obtaining basic information and forwarding the information to the CSC and Providers as quickly as possible;
  • Seeks clarification from Providers and CSC with telephone contact and follow-up where indicated. When information received is inadequate, illegible, or ill timed, places call to the Provider or CSC in order to ensure appropriate documentation for the request of authorizations;
  • Manages toll free line and requests for information.  Assists in tracking referrals, verifies Medicaid status, and tracks information.
  • Provides assistance regarding WOS for CSCs
  • Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures;
  • Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
  • Performs other tasks/responsibilities as required to support the business operations.

 EDUCATION AND EXPERIENCE REQUIREMENTS:

 Bachelor’s degree in Human Services or other related field required and at least one year of demonstrated work experience with direct client contact experience with knowledge of substance abuse and mental health issues;

  • Attends URAC trainings specific to job duties;
  • Attends annual conflict of interest training.

KNOWLEDGE/SKILLS/ABILITIES:

  • Ability to effectively communicate with clients and providers;
  • Excellent interpersonal skills;
  • Strong attention to detail; ability to work on multiple tasks and meet deadlines;
  • Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Power Point, Access, Outlook); internet;

Strong written and verbal communication skills required.

ABH® is committed to being the Employer of Choice. We were awarded one of the Best Places to Work in Connecticut in 2007 for demonstrating best practices. If your qualifications match these job requirements and you are interested in pursuing this potential position and joining a dynamic company, please apply on-line at www.abhct.com. include resume, letter of interest and salary requirements/range. 

                 ABH® is an Equal Opportunity Employer

 

CLICK HERE TO APPLY

 


We are an Equal Opportunity Employer.


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Advanced Behavioral Health, Inc.

213 Court Street
Middletown, CT 06457

Phone: (860) 638-5309
Fax: (860) 638-5302