Utilization Review Case Manager

Job Description
The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for our clients. The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight timeline.
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
This is a full-time position at our corporate office.