UR Specialist

POSITION SUMMARY: The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

MAJOR DUTIES AND RESPONSIBILITIES:

• Complete assessments and pre-certifications for clients.
• Communicate necessary information received toappropriate staffina timelyand efficientmatter.
• Demonstrate understanding of medical terminology.
• Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
• Demonstrate knowledge of EOB interpretation.
• Daily use of ten key, dataentryand spreadsheets applications.
• Communicate effectively with peers andsupervisorto address billing and claim issues.
• Follow all HIPAA, compliance,privacyand confidentiality standards.
• Participate indevelopmentof Quality Improvement projects.
• Follow all practices detailed inthe companiesPolicies and Procedures Manual and Employee Handbook.
• Attend andparticipatein staff meetings andtrainings.
• Demonstrateexpertisein Psychiatric and Addiction Disorders.
• Engage inappropriate writtenand verbal communication with families, insurance companies and otherprofessional.
• Demonstrateabilityto work with Excel,Wordand electronic chanting.
• Ability to work with minimal supervision.
• Organized and detail oriented.
• Other dutiesas assigned.

ESSENTIAL KNOWLEDGE, SKILLS, AND ABILITIES:

Knowledge: The UR Coordinator will:

• Possessproficiencyin Excel,Wordand electronic charting.
• Demonstrateabilityto multi-task.
• Demonstrateabilityto work with minimal supervision.
• Basic knowledge of HIPAA.
• Possess excellent customer service skills.
• Demonstrateabilityto work under pressure.

Abilities: To excel in this position the incumbent should be able to demonstrate the following competencies:

• Problem Solving– The UR Coordinatorwill be able toidentifyand resolve problems in efficient and effective ways.
• Ethics – Treat clients, staff, co-workers, visitors, contractors, and guests ofSunshine Behavioral Healthwith respect and dignity; work ethically and uphold the values and standardsorSunshine Behavioral Health.
• Attendance, Punctuality, Reliability – Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are coveredin the event ofan absence or scheduled vacation.
• Leadership – Constant development of staff,co-workersand clients, ineffortto achieveeach individual’shighest potential.
• Strong Character – Staying calm under pressure is essential. Having an approachable demeanor without compromisingSunshine Behavioral HealthStandards of ethics and workmanship.
• Flexibility–Openness to different and new ways of doing things; willingness tomodifyone's preferred way of doing things.
• Organization – Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them.

QUALIFICATIONS AND PREFERENCES:

• A minimum of twoyearof experience with Utilization Review.
• HS Diploma, college degree preferred.
• Excellent customer service skills.
• Valid Driver’s License.

Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind.