Utilization Review Specialist

This is a fully remote position, open to applicants in Utah.

📋 Description

• Monitor UCE/UR/Insurance deadlines for all funding and ensure timely submission of requests.

• Evaluate utilization review submissions for medical necessity, make necessary corrections, and submit for approval.

• Provide ongoing training to staff on writing for medical necessity and other utilization management topics.

• Address funding denials through immediate UR modifications and resubmissions to reduce loss of days.

• Update Best Notes and UWITS to accurately reflect authorized days.

• Generate reports with due dates, inform staff of changes, and oversee staff progress.

• Perform monthly Medicaid checks and upload snapshots to Best Notes.

• Conduct “doc-to-doc” calls as required for insurance authorization.

• Liaise with the OH billing department to resolve any issues.

• Exhibit proficiency in ASAM and DSM-V through successful authorization and processing of utilization reviews.

• Fulfill all responsibilities in a timely, comprehensive, and professional manner.

• Carry out additional duties as assigned.

⛳️ Requirements

• Licensed Mental Health Professional, including CSW, LCSW, CMHC, ACHMC, LMFT, MFTI.

• Graduate degree in a mental health-related field.

• Willingness and capability to pass a criminal background check.

• First Aid and CPR Certification (available at Odyssey House).

• Must adhere to annual TB tests and Flu immunization (and other necessary immunizations).

• Must meet employment eligibility criteria.

• Ability to work variable shifts as required.

• Capability to lift up to 15 lbs., drive (or have adequate alternate transportation), sit for extended periods, and perform light to moderate physical activities as needed.

• Ability to passively restrain residents without risk of injury to oneself due to existing medical conditions.

• Commitment to Odyssey House's mission, philosophy, scope of service, Division of Human Services Code of Conduct, and relevant service contract obligations.

• Understanding of role responsibilities, time management, personnel file requirements, client record systems, incident reporting, mandatory training, client boundaries, and individual rights.

🏝️ Benefits

• $9k per year tuition eligibility.

• Access to a 24/7 EAP program (Employee Assistance Program) for mental health support and more!

• Opportunities for paid continuing education and training.

• Monthly incentives and awards.

• Flexible scheduling.

• Casual dress and work atmosphere.

• Opportunities for bonuses, awards, raises, and promotions.

• Exceptional health insurance (medical, dental, vision, FSA, long and short-term disability).

• Immediate eligibility to participate in our 403(b) retirement plan, with Employer 100% match up to 5% after 1 year.

• 35 paid days off (additional PTO accrual after 1 year).

• EXTRA time off and gift packages for part-time and full-time staff who stay more than 90 days!

• Sabbatical Program - where we pay you to take a vacation after 5 years of service!

• On-Demand Pay - Get a portion of your paycheck early for hours already worked! (conditions apply).

• UTA free passes available for your work commute.