New job Utilization Review Specialist in Arkansas

Utilization Review Specialist

Company : UAMS Medical Center
Salary : Details not provided
Location : Arkansas

Full Description

The Utilization Review Specialist (URS) performs daily utilization management tasks with Medicaid and other insurers for clinics throughout PRI. Must have the ability to make decisions related to Medicaid regulations and create Master Treatment Plans and Master Treatment Plan Reviews. Must understand mental health diagnosis and treatment. The URS will also be responsible for keeping current all pre-authorizations for Medicaid and private insurance current for all providers in the clinics supported.
The Utilization Review Specialist completes reports related to insurance requirements, and audits related to accreditation requirements. In addition, this position may contact patients via phone calls or letters. They complete clinical and administrative processes and documentation in compliance with relevant policies and procedures, participates in staff meetings, training, supervision and continuing education activities as needed to maintain quality and coordination of care. They will also maintain the internal waiting list for group and individual psychotherapy.

The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving the health, health care, and well-being of Arkansans.

UAMS offers amazing benefits and perks:
  • Health: Medical, Dental and Vision plans available for staff and family
  • Holiday, Vacation and Sick Leave
  • Education discount for staff and dependents (undergraduate only)
  • Retirement: Up to 10% matched contribution from UAMS
  • Basic Life Insurance up to $50,000
  • Career Training and Educational Opportunities
  • Merchant Discounts
  • Concierge prescription delivery on the main campus when using UAMS pharmacy
Salary offered commensurate with experience.
  • Creates Master Treatment Plan and Treatment Plan Reviews for PRI-NW, CAST and the CSU.
  • Completes program Prior Authorizations including those for neuropsychology, and other related documentation that is required for treatment of Medicaid and private insurance clients
  • Oversees policies and procedures related to that task, as well as making recommendations regarding this system to the WFC Program Manager.
  • Completes audits and reports as assigned.
  • Participates in departmental and program trainings and staffing as required.
  • Develops and maintains organizational processes, which allow timely completion of all required work.
  • Responsibilities may include answering phone calls with patients or insurance companies, writing letters to patients on behalf of the clinical staff, assisting in the discharge process of patients, or answering patient questions regarding insurance requirements or limitations.
  • May perform other duties as assigned.
Minimum Qualifications:
  • Bachelor's degree in social work, counseling, or related mental health field
  • One (1) year of behavioral health experience (may include internships for qualification purposes only)
Preferred Qualifications:
  • Master's degree in social work, counseling, or related mental health field
  • Utilization management mental health experience in an outpatient setting
Special Knowledge, skills, abilities:
  • Experience and understanding of mental health, Arkansas Medicaid, other private insurance requirements
This position is subject to a pre-employment criminal background check and drug screen. A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law.

UAMS is an Affirmative Action and Equal Opportunity Employer of individuals with disabilities and protected veterans and is committed to excellence. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (501) 686-6432 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA).
Physical Requirements: Stand: Occasionally
Sit: Frequently
Walk: Occasionally
Bend, crawl, crouch, kneel, stoop, or reach overhead: Occasionally
Lift, push, pull, carry weight: 10 lbs or less
Use hands to touch, handle, or feel: Occasionally
Talk: Frequently
Hear: Frequently
Taste or smell: Never
Read, concentrate, think analytically: Frequently
Physical Environment: Inside Office Environment
Noise Level: Quiet
Visual Requirements: Far visual acuity, Near visual acuity
Hazards: None

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