Job description

Job Title: Utilization Review Specialist
Reports To: Corporate Director of Utilization Review

Northpoint is a growing organization dedicated to providing a safe, therapeutic environment where those struggling with addiction can build a foundation for their recovery and gain a clear vision of hope. Northpoint provides a unique setting that provides affordable and effective alcohol and drug addiction treatment, with facilities located in Boise, Idaho Seattle, Washington, Loveland, Colorado, and Omaha, Nebraska. Organizational values include humility, heart, inspiration and conviction. Our commitment to excellence means doing good for others and engaging in innovative empirical based treatment. In short, our mission is to help people get their lives back and show them respect and empathy in the process.

Northpoint has an opening for a Behavioral Health Utilization Review Specialist.

POSITION SUMMARY: As a key member of the Northpoint team, the UR Specialist is a licensed professional who is responsible for ensuring that clinically appropriate care, discharge, and cost-effective utilization of services are maintained across the treatment continuum at Northpoint. The UR Specialist, in conjunction with a multidisciplinary team, provides ongoing clinical review of patients served - from admission through discharge. The UR Specialist takes the lead in ensuring that admissions, continued stays, discharges and appeals related to service provision are reviewed and responded to in a timely and clinically sound manner in accordance with policies and procedures. The UR Specialist will serve as a strong and knowledgeable liaison between payers and the clinical care teams, working with the entire multidisciplinary team.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• Apply utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review
• Communication to third-party payers for initial and concurrent clinical review
• Review patient charts to ensure patient continues to meet medical necessity
• Document actions and information shared with care team members or third-party payer
• Alert and discuss with clinical care team and management staff when patient no longer meets medical necessity criteria for the inpatient stay
• Refer to management staff any case that surpasses expected LOC, expected cost, or over/underutilization of resources
• Perform verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per contractual obligations as applicable
• Collect data on variances in LOC, lost days, costs/barriers to discharge/transition and denied days
• Prepare appeals on denied cases when appropriate
• Able to interact and communicate effectively with patients, families, payers, and staff in a concise and descriptive manner both verbally and in writing
• In-depth knowledge of disease process, medical terminology, ASAM dimensions, and utilization review
• Exposure and use of nationally recognized criteria used to determine medical necessity
• Adhere to all company policies and procedures
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Perform other job-related duties as assigned

QUALIFICATIONS/REQUIREMENTS FOR POSITION:

• Hold active local state counselor/therapist license or RN license (Stongly Preferred)
• A minimum of 1 year experience in the field of utilization review
• Preference given to those with addiction recovery and/or mental health setting experience
• Knowledge and skills in English usage, interpersonal relationships and excellent communication skills

PREFERRED KNOWLEDGE AND SKILLS:

• Excellent critical thinking skills
• Excellent organizational abilities
• Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing
• Quickly and effectively identify and resolve problematic situations
• Comfortable analyzing information and dealing with complexity
• Attention to detail and accuracy
• Able to handle confidential material in a reliable manner
• Ability to interact and communicate with individuals at all levels of organization
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment
• Proficiency with Microsoft Office Suite

REQUIRED CERTIFICATES/LICENSES/REGISTRATIONS:

• Must hold active local state counselor/therapist license or RN license
• Must maintain current crisis prevention intervention and nationally accredited CPR/First Aid/AED certification

SUPERVISORY RESPONSIBILITIES:

• None

PHYSICAL DEMANDS AND WORK ENVIRONMENT:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must have reasonable ability to stand, walk, sit, handle, feel, reach, climb or balance, stoop, kneel, crouch or crawl, talk, hear, taste and smell
• Must be able to lift up to 10lbs
• Environment consists of inpatient, residential treatment atmosphere, as well as an out-patient treatment center setting
• Exposure to disturbed and potentially aggressive patients is possible. Stress ranges from low to intense depending on the situation

CONDITIONS OF EMPLOYMENT:

• Completion of a tuberculin screening during first week of employment
• Completion of a pre-employment drug screening, post-accident and random for upon reasonable suspicion of use
• Completion of orientation and required paperwork prior to reporting to work
• Demonstrated computer literacy
• Attendance at all mandatory staff development and training
• Completion of background and reference checks
• Must be fully vaccinated against COVID-19

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint Recovery is an At-Will employer. Employment may be terminated at any time by employee, or employer with or without notice.

Job Type: Full-time

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