Utilization Review Assistant

Monday-Friday 9:00am-5:30pm working in the UR department.
Must have prior insurance experience, both commercial and Medicaid.
Understand ASAM criteria, the disease of addiction and substance abuse treatment.
*PURPOSE STATEMENT:* Provide administrative support to the Utilization department.
*ESSENTIAL FUNCTIONS:* · Perform pre-certification and negotiate continued stay with third party payers.
· Gather data to support case management activities, including presentation of gathered data and case notes.
· Coordinate discharge planning with clinical team, maintain CRM database with discharge information and follow up.
· Present case information and the needs of third-party payers to (?).
· Assist in admissions review, concurrent reviews and discharge planning.
· Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.
· Informs management about the status of current patients; documents utilization activities as instructed.
Participates in performance improvement activities.
*OTHER FUNCTIONS: * · Perform other functions and tasks as assigned.
*EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:* · High school diploma or equivalent required.
*LICENSES/DESIGNATIONS/CERTIFICATIONS:* · Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.
Job Type: Full-time Benefits: * 401(k) * 401(k) matching * Dental insurance * Employee assistance program * Employee discount * Flexible spending account * Health insurance * Health savings account * Life insurance * Paid time off * Professional development assistance * Tuition reimbursement * Vision insurance Schedule: * 8 hour shift * Day shift * Monday to Friday Ability to Relocate: * Salem, VA 24153: Relocate before starting work (Required) Work Location: Hybrid remote in Salem, VA 24153