Job details

Utilization Review Coordinator

at Recovery Works- South Shore
Location South Shore, KY
Category Clerical / Service
Job Type Full Time

Description

Pinnacle Treatment Centers is a leading comprehensive provider of substance abuse treatment services to individuals that are addicted to drugs and / or alcohol. Founded in 2006, the Company has grown into an organization that operates over 30 substance abuse treatment facilities in five states (Kentucky, Michigan, New Jersey, Pennsylvania, and Virginia) with additional sites under development in Ohio, Indiana, and Minnesota.

Pinnacle treats over 10,000 people daily and provides a full continuum of care, including detoxification, residential, outpatient, and transitional living programs. Treatment includes treating the individual’s physical, spiritual, emotional, and psychological selves. Pinnacle is CARF accredited and all locations include physicians, nurses, clinicians, administrative, and support staff.

About the position:

Monitor and coordinate all intake and admission of clients. Provide monitoring of the department to include implementation of policy and procedures and compliance with state regulations.

 This is a highly visible position involved with presenting the Recovery Works program to potential clients, referral sources and the community at large.  Strong organization skills are required to maintain and analyze incoming calls, barriers to treatment, and appropriate follow-up for all inquiries.  

This individual is required to maintain a high level of performance.

 

Tasks and Responsibilities:

  1. Assurance of compliance with state, federal, accreditation boards laws and program policies.

  2. Manage desk time for screening and assessing incoming phone calls for potential admits.

  3. Implement other duties as assigned by the Chief of Operations or CEO including preparation for audits, inspections, re-accreditation and surveys.

  4. Assist with benefit explanation for all scheduled appointments for the day, to include monitoring and approval of financial charts.  Confer with billing office on all benefit verifications and issues.

  5. Complete admission financials on a daily basis to include confirmation of all insurance authorizations for all admissions and transitions.

  6. Provide financial counseling to clients and provide follow-up calls until financial issues are resolved.

  7. Contact all no-show appointments 30 minutes after missed appointment and complete appropriate follow-up.

  8. Ensure/Maintain and review call log on a daily basis.

  9. Assist with assessing the clinical needs of each potential admit to assure proper placement of level of care.

  10. Attend daily Flash meeting at 10 a.m.

  11. Attendance at all Department Head and staff meetings.

  12. Attendance at all staff development seminars.

  13. Collects deductibles and co/insurance payment.

  14. Assist with Utilization Reviews as needed.

  15. All other responsibilities assigned per the COO and CEO.

 

Minimum Qualifications:   Bachelor’s Degree and/or skilled training in related field, Minimum of five years of experience in related field, strong communication and computer skills multi-tasking ability, organizational skills, ability to work independently, problem solving techniques, and strong interpersonal skills. Philosophy of treatment that is compatible with facility philosophy.

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