Utilization Review Case Manager

Summary

Join Discovery Behavioral Health as a Utilization Review Case Manager and contribute to creating life-changing programs and treatment centers nationwide. You will collaborate with a team of professionals committed to positive client outcomes. This full-time remote position requires effective communication and coordination with various stakeholders to maximize client benefits. You will submit accurate utilization reviews, perform assessments, conduct chart reviews, and ensure authorization accuracy. The ideal candidate possesses strong knowledge of ASAM dimensions, DSM-V codes, and experience in utilization review for substance use facilities. Discovery Behavioral Health offers competitive compensation, comprehensive benefits, and opportunities for professional development.

Requirements

Flexibility with schedule to meet critical deadlines is essential

Responsibilities

• Determine client medical necessity for insurance claims using various criteria and dimensions as dictated by the insurance carriers
• Work to build a case for medical necessity for potential clients
• Perform pre-intake assessments for potentially viable clients
• Work closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of care
• Conduct chart reviews to ensure clinical documentation matches level of care requested
• Ensure that authorization match the authorization obtained by you for the correct authorization number, the LOC , the facility, the number of days and the date range
• Understanding DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all Levels of care
• Communicate effectively, both written and verbal, with supervisor and all pertinent staff on your clients
• File appeals for denied cases and follow through on that process
• Timely, organized documentation. Record keeping must be accurate and thorough
• Demonstrate the ability to act as a team player in a professional and positive manner

Preferred Qualifications

• Master’s Degree minimum
• Licensed LMFT, LCSW, LVN, or RN
• Prior experience in doing utilization review for substance use facilities
• Strong knowledge of ASAM dimensions 1-6
• Knowledge of DSM-V Codes
• Knowledge of SUD,IOP, and Mental Health programs

Benefits

• 401(k)
• Healthcare benefits
• Vacation and sick days
• Employee referral program
• Employee discounts to various stores, amusement parks, events, etc
• Continuing education (CE) programs and training
• Weekly training opportunities
• Advancement opportunities within the organization