Bradford Health Services is an industry leader in providing hope and healing with substance use disorders and associated co-occurring disorders. Just as each treatment plan is different, each career path at Bradford is different. Take a step forward in your career with Bradford Health Services.

Position Summary:

The Utilization Review Coordinator completes coordination of the facilities insurance certification including precertification and continued stay reviews, as well as follow up on all insurance denials, appeals and reconsiderations. The successful candidate will need to reside in Alabama or Mississippi licensed in their home state with either RN, LPC, or LCSW license and experience in utilization review. This is a remote position.

Supervisory Responsibilities:

N/A

Duties/Responsibilities:

• Perform all preadmission certification reviews, continued stay reviews, appeals, denials and/or reconsiderations and provide information to the appropriate review agency or insurance company
• Maintain an “UR Activity Log” which records every review for the facility with financial classification and U.R. information/activity
• Maintain a “call back” calendar for continued stay reviews and maintain a U.R. file for each patient
• Document, in the patient electronic record software, the review with the managed care organization, including the level of care requested, the status of the request, outcome and information about the next review
• Review and maintain all correspondence pertaining to certification, appeals, denials or reconsiderations, and ensure they are scanned into the patient electronic health record
• Complete all Quality Improvement indicators for Utilization Management, data analysis and reporting
• Educate counseling staff regarding data needed to adequately document patient care and educate crisis staff regarding data needed to adequately document intake assessments and managed care criteria
• Ability to work in a constant state of alertness as to perform the job safely
• Ability to work in cooperative manner with co-workers, managers, clients and prospective managers
• Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records,” and 45 CFR “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and patient health information.
• Regular attendance
• Any other duties as assigned by supervisor

Required Skills/Abilities:

• Must have 2 years of experience in utilization preferred
• Must possess good grammatical and communication Skills
• Must be skilled in Microsoft Office applications and have a working knowledge of office equipment
• Must have the ability to self manage in a remote environment

Education:

Physical Requirements:

• Must be able to read and comprehend hand-written, printed, and on-line treatment notes and plans
• Must be able to hear and comprehend conversations and instructions
• Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift
• Must be able to walk within the facility a total of approximately two (2) hrs. per day
• If recovering, two years of continuous verifiable abstinence

We Offer:

• A competitive salary plus benefits
• Generous Paid Time Off
• Professional growth opportunities