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Company:
Valley Hope Association
Posted: July 3, 2024
Utilization Review Clinician: Full-time; Monday - Friday 8am-5pm
Valley Hope has an exciting full-time opportunity for anUtilization Review Clinician to join our team.
Are you ready to join an organization where you can make an extraordinary impact, conquering addiction one patient and family at a time? If so, Valley Hope welcomes you!
EDUCATION & EXPERIENCERequired:
• ZR
Valley Hope has an exciting full-time opportunity for anUtilization Review Clinician to join our team.
Are you ready to join an organization where you can make an extraordinary impact, conquering addiction one patient and family at a time? If so, Valley Hope welcomes you!
EDUCATION & EXPERIENCERequired:
- Clinical credential such as a counselor certificate or nursing license (RN or LPN).
- Three years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
- License or credential to function as an alcohol and drug treatment counselor in the state in which the Counselor is working.
- CPR/First Aid Certification
- Master's degree in a behavioral healthcare related field
- Five years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.
- Starting salary range - $64,000 - $78,000 (Based on education and experience)
- Affordable health, dental, and vision insurance
- Tuition Assistance
- Student Loan Repayment
- Public Student Loan Forgiveness (PSLF) Eligible Employer
- 8 Paid Holidays (Including 1 Personal Holiday)
- PTO - Up to 27 Days per year based on years of service
- Paid Parental Leave
- 401(k) Retirement Plan with employer match
- Health Saving and Flexible Spending Accounts
- Employee Assistance Program
- And much more!
- Provide support services to review and coordinate clinical utilization and external payer expectations for each patient admission where external payment options exist.
- Serve as a clinical resource person for the health care team when determining appropriateness of admission and continued stays.
- Gather required clinical information and report to insurance company's patient's progress and plan to receive authorization for continued stay.
- Maximize certified patient days that are clinically appropriate and available as benefits
- Assist with insurance pre-certifications for patients who are admitted during regular shift hours and follow up on pre-certifications that are performed or initiated during off-shift hours.
- Appeal denials of certified days when it is in the best interests of both the patient and Valley Hope to do so.
- Effectively communicate patient status information with the business office, nursing, and counselor.
- Regularly review medical necessity guidelines for managed care partners.
- Communicate information to appropriate staff members to assist in discharge planning efforts
- Provide effective documentation to Valley Hope contract physicians and/or other clinical staff to assist with peer to peer reviews.
- Inform UR Manager of any ongoing trends/issues occurring with managed care companies.
- Completesany requiredcontinuingeducationcredits.
- Maintainscurrent statelicense/certification.
- Sitting for extended periods of time; regularly talking to and listening to others.
- Able to work at a rapid pace for long periods of time (typically no longer than 8 hours).
- Abletopush,pull,pullup,bendatthekneesandwaist,twistbodyatthewaist,raiseandholdarmsoverhead,turnhead-neck-shoulders as needed, grasp other items with hands, for either extended periods of time or many times throughout the workday.
• ZR
Read the full job description and apply online on the recuiter's web-site
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