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Weekday Insurance Utilization Review Jobs in Ohio

ABHS

Primary Therapist

Lancaster, OH · On-site

$60K - $70K/yr

Ensure all documentation supports the "Medical Necessity" of the residential level of care for insurance utilization reviews (UR). 4. Multidisciplinary Collaboration * Participate in weekly Treatment ...

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Weekday Insurance Utilization Review information

What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?

AspectWeekday Insurance Utilization ReviewWeekday Claims Processor
Primary RoleAssessing medical necessity and appropriateness of servicesProcessing and reviewing insurance claims for payment
CredentialsOften requires healthcare or insurance certificationsTypically requires insurance or administrative experience
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, healthcare offices
FocusMedical review and authorizationClaims data entry and verification

Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.

What are the most commonly searched types of Insurance Utilization Review jobs in Ohio? The most popular types of Insurance Utilization Review jobs in Ohio are:
What cities in Ohio are hiring for Weekday Insurance Utilization Review jobs? Cities in Ohio with the most Weekday Insurance Utilization Review job openings:
Weekday Insurance Utilization Review jobs near you

Primary Therapist

ABHS

Lancaster, OH • On-site

$60K - $70K/yr

Full-time

Posted 15 days ago

Job description

Job Summary

The Primary Therapist is the primary clinical lead for an assigned caseload of residents within the facility. The Primary Therapist is responsible for the creation, implementation, and regular review of Individualized Treatment Plans (ITPs). This role involves providing high-intensity therapeutic interventions, conducting comprehensive biopsychosocial assessments, and ensuring that all clinical services meet the "Medical Necessity" standards for residential care. The Primary Therapists work as part of a multidisciplinary team to move residents toward successful community reintegration.


Essential Duties and Responsibilities

1. Clinical Assessment and Treatment Planning

  • Conduct comprehensive biopsychosocial assessments for new residents within the state-mandated timeframes.
  • Develop, write, and update Individualized Treatment Plans (ITPs) as required by the state regulatory bodies, ensuring goals are SMART (Specific, Measurable, Achievable, Relevant, Time-bound) and reflect the resident’s voice.
  • Interpret clinical data to identify trends in resident behavior and adjust treatment strategies accordingly.

2. Therapeutic Interventions

  • Provide individual, group, and family therapy sessions utilizing evidence-based modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or Trauma-Informed Care (TIC).
  • Facilitate specialized clinical groups focused on symptom management, emotional regulation, and recovery skills.
  • Provide clinical "real-time" intervention and de-escalation for residents experiencing acute psychological distress.

3. Documentation and Regulatory Compliance

  • Maintain precise and timely clinical documentation in the Electronic Health Record (EHR) according to state regulations and national accreditation bodies (Joint Commission).
  • Prepare comprehensive discharge summaries and transition plans in collaboration with the Case Manager.
  • Ensure all documentation supports the "Medical Necessity" of the residential level of care for insurance utilization reviews (UR).

4. Multidisciplinary Collaboration

  • Participate in weekly Treatment Team meetings to provide clinical updates.
  • Provide clinical consultation to Behavioral Health Technicians (BHTs) to ensure the therapeutic milieu is consistent with residents’ treatment goals.
  • Coordinate with external providers to ensure a seamless continuum of care.


Qualifications

Education and Experience

Minimum Requirement: Master’s degree from an accredited college or university in a human services field (Social Work, Psychology, Counseling, or related).

Experience: Minimum of two (2) years of post-graduate clinical experience in a mental health setting. Residential experience is preferred.

Licensure: Preferred to be a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), or Licensed Marriage and Family Therapist (LMFT) in the state of practice. Associate licensed Master's-level candidates considered with residential experience and eligibility to obtain clinical licensure within one year of hire.


Monday-Friday 8:30am-5:00pm