[Hiring] Utilization Review @HCANA

Role Description

The Utilization Review (UR) Specialist is responsible for managing the authorization process between HCANA facilities and third-party payers. This role ensures that all services provided—from detox to residential and intensive outpatient care—meet the criteria for medical necessity. The UR Specialist acts as a clinical advocate, utilizing clinical documentation to secure initial, concurrent, and retrospective authorizations, thereby ensuring the financial viability of the treatment provided and the continuity of care for our clients.

Qualifications

• Prior Utilization Review or Billing experience in a substance use treatment or medical setting is a plus.
• Prior experience with electronic medical records a plus, especially KIPU knowledge.
• Knowledge of ASAM criteria a plus.

Requirements

• High school diploma or GED.
• 18 years of age or older.
• Complete and pass pre-employment requirements, such as a background check and drug test, as outlined by HCANA policies.
• Ability to set priorities, maintain accurate medical records on each client in accordance with the treatment plan and facility policies and procedures.
• Strong interpersonal skills and ability to communicate with co-workers effectively and efficiently.

Benefits

• This job may require some after-hours work, as well as some hours on the weekend.
• For this reason, office hours may be flexible, with the option to work remotely, upon completion of training.