Utilization Review Case Manager - Substance Abuse Disorder (SUD)

Summary

Join Discovery Behavioral Health's growing team as a Utilization Review Case Manager, working collaboratively with insurance companies and treatment teams to obtain maximum benefits for clients.

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