[Hiring] Utilization Review Clinician @Valley Hope Addiction Treatment & Recovery

Role Description

Valley Hope has an exciting full-time opportunity for a Utilization Review Clinician to join our team. This position can be performed remotely by candidates residing in cities in which Valley Hope operates.

• Provide support services to review and coordinate clinical utilization and external payer expectations for each patient admission where external payment options exist.
• Serve as a clinical resource person for the health care team when determining appropriateness of admission and continued stays.
• Gather required clinical information and report to insurance company’s patient’s progress and plan to receive authorization for continued stay.
• Maximize certified patient days that are clinically appropriate and available as benefits.
• Obtain and assist with insurance pre-certifications for patients who are admitted to treatment.
• Appeal denials of certified days when it is in the best interests of both the patient and Valley Hope to do so.
• Effectively communicate patient status information with the business office, nursing, and counselor.
• Regularly review medical necessity guidelines for managed care partners.
• Communicate information to appropriate staff members to assist in discharge planning efforts.
• Provide effective documentation to Valley Hope contract physicians and/or other clinical staff to assist with peer to peer reviews.
• Inform UR Manager of any ongoing trends/issues occurring with managed care companies.
• Complete any required continuing education credits.
• Maintain current state license/certification.
• Adhere to Valley Hope’s clinical philosophies, policies, and procedures as well as any other regulating bodies to ensure quality patient care.
• Participate in all assigned staff meetings, staff development, and training as required.
• Interact and communicate with others (patients, co-workers, management, and vendors) in a professional and tactful manner including treating them with respect and consideration regardless of their status or position.

Qualifications

• Licensed to practice as a master’s level licensed clinician or nurse (RN or LPN) in the state of employment.
• Three years of behavioral healthcare clinical counseling, nursing, or clinical case management experience.

Requirements

• Five years of behavioral healthcare clinical counseling, nursing, or clinical case management experience (preferred).
• Previous utilization review and/or utilization management experience (preferred).

Benefits

• Medical coverage — Valley Hope pays up to 85% of premiums.
• Dental & vision plans at competitive rates.
• Up to 27 days of PTO (based on position and tenure).
• 8 paid holidays (including a personal day).
• Paid parental leave.
• 401(k) with employer match.
• Tuition assistance to grow your career.
• Student loan repayment support.
• Public Student Loan Forgiveness (PSLF) eligible employer.
• HSA & FSA options to manage healthcare costs.
• Employee Assistance Program (EAP) for added support.
• And more perks designed with you in mind!