Utilization Review Specialist
Utilization Review Specialist
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 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 20% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!
We are currently looking for a Utilization Review Specialist to join our Northern Arizona Team! Work schedule is 40 hours per week. This position can be housed out one of the following clinics only: Lake Havasu, Bullhead City, Kingman, Prescot Valley, or Flagstaff.
Staff is responsible for:
Utilization Review/Quality Assurance. Performs care coordination functions, chart audits, prior authorizations for care, Notices of Action, appeals and discharge coordination as needed. These functions include clinical care coordination between resources within and outside the agency, monitoring compliance with C.O.T. rules and regulations, and authorizations for stay at residential units.
- Works collaboratively with Behavioral Health Medical Practitioners, Psychologists, Registered Nurses, and all other direct service providers.
- 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.
- Follow up with CFS addressing issues related to eligibility and enrollment.
- Follow up with Care Coordinators 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 services. Trouble shoots and resolves barriers with securing authorization for services.
- Initiates and oversees retro and reconsideration authorization processes to ensure authorizations for services are secured timely.
Education and Qualifications:
- Minimum requirement consists of a Bachelor’s degree with two years of full-time behavioral health experience (or equivalent)
- Must have fingerprint clearance issued by the Arizona Department of Public Safety or be eligible to receive within eight (8) weeks of hire (as required per program requirements).
- Valid AZ driver’s license & Motor Vehicle clearance.
- Utilization Review and/or case management experience working with adults and/or special populations.
- An equivalent combination of education and experience directly related to behavioral health totaling six years is acceptable.
- A working understanding of Arizona regulations related to the care of Seriously Mental Ill adults and individuals on Court Ordered Treatment preferred.
- Bilingual (English/Spanish) speaking preferred.
- Strong computer skills operating Microsoft Excel highly preferred