Utilization Review Case Manager

The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for our clients.  The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight timeline. ResponsibilitiesDetermine client medical necessity for insurance claims using various criteria and dimensions as dictated by the insurance carriersWork to build a case for medical necessity for potential clientsPerform pre-intake assessments for potentially viable clientsWork closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of careConduct chart reviews to ensure clinical documentation matches level of care requestedEnsure that authorization match the authorization obtained by you for the correct authorization number, the LOC , the facility, the number of days and the date range.Understanding DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all Levels of care.Communicate effectively, both written and verbal, with supervisor and all pertinent staff on your clients.File appeals for denied cases and follow through on that processTimely, organized documentation.  Record keeping must be accurate and thorough.Demonstrate the ability to act as a team player in a professional and positive mannerThis is a full-time position at our corporate office.