• Utilization Review Specialist

    Posted Date 1 week ago(7/8/2019 11:35 AM)
    Requisition ID
    2019-60771
    Category
    Professional
    Position Type
    Regular Full-Time
    Department
    ICE BHSL WFC Clinical Team
    Post End Date
    7/23/2019
  • Overview

    The Utilization Review Specialist (UM) works directly under the supervision of the Walker Family MHP supervisor and indirectly under the supervision of the Walker Family Clinic Program Manager to perform daily utilization management tasks with Medicaid and other insurers. The UM completes 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.  

     

    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 patient care and the lives 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:  Negotiable

    Responsibilities

    • Completes all program Prior Authorizations and other related documentation that is required for treatment of Medicaid and private insurance clients.
    • Over-sees policies and procedures related to that task, as well as making recommendations regarding this system to the WFC Supervisor and WFC Program Manager.
    • Participates in departmental and program trainings and staffing as required.
    • Develops and maintains processes that allow timely completion of all required work.
    • Responsible for continual education regarding Medicaid regulations and is available to educate clinical staff regarding these requirements.
    • Responsible for phone calls with patients or insurance companies, writing letters to patients on behalf of WFC Supervisor, WFC Program Manager or other clinical staff as needed.
    • Assisting in the discharge process of patients and answering patient questions regarding insurance requirements or limitations.
    • Responsible for keeping current all pre-authorizations for Medicaid and private insurance current for all providers in the Walker Family Clinic. 
    • Interacts with and assists the public in a professional and friendly manner as needed. 
    • Demonstrates positive working relationships with co-workers, management team, and ancillary departments.
    • Follows the Core Concepts of Patient and Family Centered Care and the Basic Code of Conduct Guidelines.
    • Assist internal and external stakeholders as needed with exceptional customer service
    • Other duties as assigned.

    Qualifications

    Minimum Qualifications:

    • Bachelor’s degree in social work, counseling or a related mental health field plus 1 year of utilization management or administrative experience, working in mental health (in an out-patient setting).

    Skills:

    • Must have the ability to make decisions related to Medicaid and insurance regulations. 
    • Must be able to complete treatment plans for doctors and residents.
    • Must understand mental health diagnosis and treatment.  

    Preferred Qualifications:

    • 2 years of experience working in an out-patient mental health facility.

    This position is subject to a pre-employment criminal background check.  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.

    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: Continuously
    Hear: Continuously
    Taste or smell: Never
    Read, concentrate, think analytically: Continuously
    Physical Environment: Inside Office Environment
    Noise Level: Quiet
    Visual Requirements: Depth perception, Far visual acuity, Near visual acuity
    Hazards: None

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