Employer: Triumph Treatment Services
The Utilization Review Specialist will submit articulate and timely utilization reviews in order to assure payment for patients who are participating in residential treatment. They will accomplish this goal by evaluating medical necessity with the multidisciplinary team, accurately applying ASAM criteria, and effectively reporting the need for the continued stay to the properly managed care organization (MCO).
Successful applicants will:
High School diploma or GED required.
State Clinical License preferred.
2-3 years experience in a healthcare environment or related field preferred.
Benefits & Compensation:
The hourly range for this position is $19.70 - $26.55.
We offer a comprehensive benefits package (full-time employees) including:
Medical, dental, vision, life, and supplemental insurance
Health savings, flex spending, and dependent care accounts
Life AD & D and Long-Term Disability
401K with employer matching
For more detailed information on benefits click here: https://triumphtx.org/wp-content/uploads/2022/03/EE-Benefit-Summary-03.29.22.pdf
Utilization Review Specialist Job Responsibilities:
Maintain and apply a high level of understanding of ASAM and WAC criteria for all levels and dimensions of treatment needs.
Develop and preserve collaborating relationships with internal and external partners in client case management.
Track and communicate residential authorization periods and discharge planning needs.
Utilize strong written and verbal communication skills to advocate on behalf of the client to secure insurance coverage for needed services.
Partner with clinical supervisors to ensure client medical records accurately reflect client participation in treatment plan goals, supporting their continued need for treatment. When necessary, train clinical team members in order to strengthen skills in the area of documentation.
Correspond with physicians to correct errors or omissions and to investigate questionable claims.
Modify client treatment plans as indicated by the client’s responses or case history.
Audit and analyze client records to ensure quality client care and appropriateness of services.
Reviews clinical documentation from denied days or admissions against criteria to determine if documentation is adequate for the requested treatment.
Maintaining an efficient, positive customer service attitude towards clients, their families, and team members while being responsive to clients’ needs.
Application Method: Apply online https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=8118bb9e-8ba4-4e6d-a3ae-a47c7d101c03&ccId=19000101_000001&type=JS&lang=en_US&selectedMenuKey=CareerCenter&jobId=490194
Base Pay: $19.70 - $26.55 per hour
2011 W. Washington Ave
Yakima, WA 98903