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Assesses need for continued care for patients, applies utilization review concepts according to federal, state, and JCAHO guidelines. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
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Responsibilities Below is a list of your responsibilities as a Utilization Management Specialist 2 with YesCare : Responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice.
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Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for patients and their benefit/resource utilization.
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Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the Utilization Management team for concurrent reviews.
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The BH Care Manager I responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
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Participates in Southwestern Mental Health Center, Inc. peer review utilization and quality assurance projects and procedures. Provides individual, group, and family psychotherapy or skill building activities (within limits of experience and education background) including assessment, treatment planning, treatment, referral, termination, and emergency/crisis intervention services, as indicated to meet the needs of clients, including addressing failure to appear clients before 3rd consecutive no-show visit.
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Knowledge of acute psychiatric treatment, treatment settings/clinical level of care guidelines, psychiatric diagnoses, behavioral health utilization review and appeals procedures.
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Meet with ABA supervisors bi-weekly to review client progress, data collection, specific curricula/goals, functional behavioral analysis, and utilization of authorized hours. Serve as a leader in one of our Autism Learning Centers on the South Coast, collaborating with senior leaders and a team of internal and external consultants to provide state-of-the-art services to children on the Autism Spectrum, combining Skill-Based Treatment and Pivotal Response Treatment.
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Attend and participate in assigned case conferences, treatment planning meetings and utilization review. Assess and review medication regimen with patient, guardian(s), team members and other care providers/advocates.
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River Oaks Hospital is seeking a dynamic and talented UTILIZATION REVIEW COORDINATOR who Evaluates patient medical records to determine severity of patient's illness and the appropriateness of level of care.
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The Utilization Review Specialist performs studies/reviews of medical records to monitor and to determine that the quality of clients' treatment and care are maintained at the highest level.
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Ranked by Newsweek in 2020 and 2021 as one of North Carolina's Best Addiction Treatment Centers, Wilmington Treatment Center is North Carolina's premier substance abuse recovery hospital and rehabilitation center located in the beachside community of Wilmington, NC. What began as a 22 bed hospital on one campus in 1984 has grown into a 260 bed hospital spanning 3 campuses.
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Performs Utilization Review for each admission as needed and ensures overall compliance with follow-up UR as appropriate. Accurately follows up on Utilization Review activities, with documentation in the appropriate format.
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Participates in the utilization review, performance improvement and interdisciplinary conference of the organization. Under the direction of the Occupational Therapist, provides treatment to patients requiring occupational therapy services within the homecare setting.
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Accelerate Your Career as You You'll provide comprehensive and accurate clinical utilization review and dispensing services. We're redefining what a pharmacy can do, with fast and reliable prescription delivery, tools like treatment reminders and medication bundling, direct access to care specialists, and support with insurance and cost savings.
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utilization review treatment jobs
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