Utilization Review Liason

Job Details

Job Summary:  This position is responsible for all utilization review and activities related to Gateway Rehab/Aliquippa patients with managed care oversight.  This position is also responsible for monitoring and documenting all utilization review activity of patients in the Gateway Rehab for residential programs.  This job would be remote with some office time in Pittsburgh, PA.

 

Benefits for Qualified Positions Include:

  • Above Regional Market Start rate
  • Very Generous PTO Available Immediately
  • Competitive Benefits: Health, Dental, and Vision Insurance
  • Life Insurance
  • Short and Long Term Disability
  • 401(k) Retirement Plan with employer matching and more

Essential Functions: 

  • Gathers clinical information needed for concurrent reviews.
  • Completes concurrent review process with the payor for treatment.
  • Enters daily authorization information into patient database.
  • Communicates authorization status to clinical staff.
  • Monitors the last covered payment day for self-pay patients and alerts appropriate clinical staff.
  • Investigates and resolves problems with incomplete or missing authorizations.
  • Coordinates the process for seeking alternate funding when appropriate.
  • Provides recommendations to the write-off committee on denied claims in which efforts to obtain payment have been exhausted.
  • Instructs clinical and support staff on managed care procedures and communicates managed care procedure changes.
  • Coordinates managed care on-site and phone reviews.
  • Investigates denied claims for services provided to recapture payment as needed.
  • Attends managed care provider meetings as needed.

 

Qualifying Education, Experience and Skill Requirements:

  • Associates degree required; Bachelor’s degree preferred.
  • Computer proficiency with working knowledge of Word, Excel, and use of e-mail.
  • Excellent verbal and written communication skills and organizational skills.

Familiarity with drug and alcohol/mental health treatment and/or managed care processes required

 

This is a brief summary of duties not intended to be inclusive and subject to change.

Compliance with all applicable licensing/accreditation bodies required.

Gateway Rehab proudly offers competitive wages and benefit packages, along with career advancement opportunities. Join us today

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