Weekend Utilization Review Jobs in Commack, NY (NOW HIRING)

Our organization is committed to delivering exceptional care to those we support. By prioritizing client-centered services, we have established ourselves as leaders in the fields of addiction treatment, mental health recovery, and eating disorder therapies.

We provide a wide range of behavioral healthcare services, including psychiatry, addiction recovery, and mental health treatment, designed to empower clients at every stage of their recovery journey to regain their health and well-being.

• Conduct admission, ongoing stay, and discharge evaluations for all managed care clients.
• Foster positive relationships with referral sources and insurance providers.
• Monitor admissions, ongoing stay, and discharge ASAM requirements for county referrals.
• Keep an organized reporting system for counselors regarding ASAM deadlines and review calls.
• Ensure current insurance eligibility information is maintained through systems like EVS and Navinet.
• Verify census data for funding accuracy.
• Participate in clinical staffing to gather information for client evaluations.
• Accurately maintain the daily Utilization Review (UR) database.
• Conduct Act 106 reviews and manage follow-up appeals.
• Document all county referrals related to admission calls.
• Engage in chart reviews to confirm that all necessary paperwork is completed.
• Collaborate with the Billing Department to minimize uncovered funding days and investigate cases with insurance and referral sources to recover lost funding days.
• Provide weekly reports to the Assessment Manager.
• Oversee all self-pay clients and those with copays, deductibles, coinsurance, and liabilities.
• Work to reduce client balances.
• Perform additional tasks as assigned.

It is essential to provide accurate information to ensure comprehensive financial coverage for each client day. Timely communication with referral sources is crucial for maintaining a strong customer focus. Upholding client confidentiality and ensuring a safe therapeutic environment are paramount. Candidates should possess:

• Knowledge of local, state, and federal regulations.
• Understanding of facility contracts and agreements.
• Familiarity with medical terminology, appeal processes, and medical record composition.
• Proficiency in data entry, particularly in Excel, and basic mathematics.
• Awareness of the pre-certification process and ASAM standards.
• Knowledge of CARF standards, information release protocols, and confidentiality.
• Familiarity with DSM V, private care managers, and county referral sources.

Applicants should have:

• An Associate Degree or equivalent; a Bachelor of Science in Behavioral Health is preferred.
• Intermediate computer skills, including experience with Microsoft Office (Excel and Word).
• 3-5 years of experience in Utilization Review or a related role within a healthcare environment.

The ideal candidate will demonstrate:

• Professionalism and leadership qualities.
• Strong communication skills and the ability to manage time effectively.
• Organizational skills and the ability to interact positively with individuals from diverse backgrounds.
• Excellent oral and written communication abilities.
• Problem-solving skills, with a capacity to analyze information and work collaboratively.
• Consistency in interactions with clients, staff, visitors, and the public.
• The ability to handle crises calmly and make ethical decisions.
• A proactive approach and initiative in driving improvements.

The starting pay for this position is $20 per hour, with final compensation based on skills, experience, and qualifications.

We are dedicated to embodying our CORE values, which inspire our team and guide our actions. Employees are expected to align with these principles:

• Integrity: Commitment to honesty, transparency, and ethical behavior.
• Dedication: A steadfast commitment to providing exceptional care and support.
• Collaboration: A team-oriented approach to achieving excellence.
• Passion: A genuine desire to improve lives and support our mission.

• Medical, Dental, and Vision Insurance
• Flexible Spending Accounts
• Life Insurance
• Paid Time Off
• 401(k) with Company Match
• Tuition Reimbursement
• Employee Recognition Programs
• Referral Bonus Opportunities
• And more!

If you are interested in learning more about our organization and the opportunities for personal and professional growth, we encourage you to explore further.

We take pride in our diverse workforce and are an Equal Opportunity Employer.