If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Full Time WA, US Salary Range: $55,000.00 To $65,000.00 Annually POSITION SUMMARY The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary. MAJOR DUTIES AND RESPONSIBILITIES Complete assessments and pre-certifications for clients. Communicate necessary information received toappropriate staffina timelyand efficientmatter. Demonstrate understanding of medical terminology. Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions. Demonstrate knowledge of EOB interpretation. Daily use of ten key, dataentryand spreadsheets applications. Communicate effectively with peers andsupervisorto address billing and claim issues. Follow all HIPAA, compliance,privacyand confidentiality standards. Participate indevelopmentof Quality Improvement projects. Follow all practices detailed inthe companiesPolicies and Procedures Manual and Employee Handbook. Attend andparticipatein staff meetings andtrainings. Demonstrateexpertisein Psychiatric and Addiction Disorders. Engage inappropriate writtenand verbal communication with families, insurance companies and otherprofessional. Demonstrateabilityto work with Excel,Wordand electronic chanting. Ability to work with minimal supervision. Organized and detail oriented. Other dutiesas assigned. ESSENTIAL KNOWLEDGE, SKILLS, AND ABILITIES Knowledge: The UR Coordinator will: Possessproficiencyin Excel,Wordand electronic charting. Demonstrateabilityto work with minimal supervision. Basic knowledge of HIPAA. Demonstrateabilityto work under pressure. Abilities Abilities: To excel in this position the incumbent should be able to demonstrate the following competencies: Problem Solving– The UR Coordinatorwill be able toidentifyand resolve problems in efficient and effective ways. Ethics – Treat clients, staff, co-workers, visitors, contractors, and guests ofSunshine Behavioral Healthwith respect and dignity; work ethically and uphold the values and standardsorSunshine Behavioral Health. Attendance, Punctuality, Reliability – Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are coveredin the event ofan absence or scheduled vacation. Leadership – Constant development of staff,co-workersand clients, ineffortto achieveeach individual’shighest potential. Strong Character – Staying calm under pressure is essential. Having an approachable demeanor without compromisingSunshine Behavioral HealthStandards of ethics and workmanship. Flexibility–Openness to different and new ways of doing things; willingness tomodifyone's preferred way of doing things. Organization – Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them. QUALIFICATIONS AND PREFERENCES A minimum of twoyearof experience with Utilization Review. Valid Driver’s License. Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind. #J-18808-Ljbffr
...Cross Country Nurses is seeking a travel nurse RN Telemetry for a travel nursing job in San Antonio, Texas. Job Description & Requirements... ...Valid certification(s) in Basic Life Support (BLS); no prior experience required Preferred Qualifications: Prior Med-surg...
...work, and play. Together, the properties we own and operate generate $20 billion for the region's economy. With... ...the growth and prosperity of our region. As a Heavy Equipment Operator (Bargaining Unit, Local Union No. 25), you are technically skilled and detail-oriented...
Data Analyst, MidThe Opportunity:As data analyst, you love diving into data and turning it... ...superior demonstration of our values. Full-time and part-time employees working at least 20... ...have their cameras on during meetings.Remote: If this position is listed as remote,...
...com . About the Role OpenGov is looking for Product Engineer Interns who are eager to learn what it means to own a product from... ...you have a background or strong interest in product management, UX design, engineering, or some combination and you want real ownership...
...Heavy Equipment OperatorAt NPL, part of The Centuri Organization, our employees are part of an... ...something bigger. As an experienced Equipment Operator, after paid training, you will put your... ...DOT medical cardJoin and maintain Union membershipCenturi and its subsidiary...