Utiliz Review Spec
Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over one thousand employees, and over 40 years’ experience.
Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 40% company match after 1 year of service. Generous PTO includes 3 weeks of vacation your 1st year and accruals after 2, 5 and 10 years of service! We offer low cost -medical, dental, STD, LTD, and Life coverage for employees. Other great benefits include 10 paid holidays, sick time, vision, tuition reimbursement prescription drug discounts, chiropractic services, and much more!
We are currently looking for a creative, hard working Utilization Review Specialist to join our growing Kingman Recovery Unit Team! Work schedule is 40 hours per week with full time benefits.
Duties & Responsibilities:
- Completes Certificate of Need (CON), and Re-Certification of Need (RON) documents.
- Daily contact with RBHA to secure authorizations and/or Letters of Authorization (LOA) for consumers stays documentation of contact in authorization log and follows up when necessary with the T/RBHA.
- Obtains authorizations from T/RBHAs and insurance plans when necessary.
- Works collaboratively with Behavioral Health Medical Practitioners, Psychologists, Registered Nurses, CRU Care Coordinators, UM/QM Director, and Behavioral Health Technicians.
- Follow up with internal and external agencies to address issues related to eligibility and enrollment.
- Follow up with BHMPs, Care Coordinators, and nurses to ensure clear documentation of medical necessity in charts.
- Daily tracking of all authorizations, with use of Excel spreadsheet, to ensure correct authorization numbers and dates of service.
- Daily communications with fund sources to secure authorization for inpatient services. Trouble shoots and resolves barriers with securing authorization for inpatient services.
- Initiates and oversees retro and reconsideration authorization processes to ensure authorizations for inpatient services are secured timely.
- Collects referral information regarding those referred for CRU services.
- Completes medical record reviews for division (re: inpatient, residential, and outpatient services).
- Completes Discharge Ready and Crisis Report of Discharged Patient Reports.
- Works with a multi-disciplinary team on discharge planning activities.
- Assesses consumers in accordance with established policies and procedures and clinical protocols.
- Develops and maintains appropriate level of relationships with consumers and formal/informal support systems.
- Notifies shift supervisor of actual or potential challenges with consumers; i.e., non-compliance, decompensation, and crisis immediately.
- Collects eligibility information regarding those referred for CRU services.
- Provides face-to-face crisis intervention as needed.
- Maintains accurate, thorough and current documentation of contact with consumers, treatment progress and services received/provided.
- Ensure CONFIDENTIALITY in all areas of service corporate wide.
- Attends Utilization, Care Coordinator, and “All Staff” meetings (on site) as scheduled.
- To ensure compliance & adequate services, additional job duties may be required to meet the needs of the program and or department.
Education and Qualifications:
- Minimum requirement consists of a 21-year age
- Minimum requirement consists of a Bachelor’s degree with two years of full-time behavioral health experience (or equivalent)
- An equivalent combination of education and experience directly related to behavioral health totaling six years is acceptable.
- Valid AZ driver’s license & Motor Vehicle clearance.
- A working understanding of Arizona regulations related to the care of Seriously Mental Ill adults and individuals on Court Ordered Treatment.
- Utilization Review and/or case management experience working with adults and/or special populations.
- Bilingual (English/Spanish) speaking
- Strong computer skills operating Microsoft Excel.
SB&H is a drug-free workplace, drug screening required. EOE