Offer summary

Qualifications:

Master's degree and licensed in counseling (APC/LPC, LMFT, LMSW/LCSW) or Registered Dietitian., Experience in utilization review and case management preferred., Experience in a business or corporate setting is preferred., Experience in Eating Disorders is preferred..

Key responsabilities:

Perform Utilization Review including pre-authorization, concurrent and retrospective reviews for inpatient/outpatient services.

Act as a liaison to treatment team members using clinical expertise and payor knowledge.

Participate in case conferences and maintain required documentation in information systems.

Collaborate with multiple leaders to support and improve the UR Department.

Job description

The Company

Alsana is an eating disorder recovery community with 8 locations nationwide, plus our virtual program. We provide superior and committed care to help those on their journey to a healthy and successful recovery. From the Latin roots meaning “all” or “total health,” Alsana offers a new philosophy of care centered on our clients’ full well-being. We address the aspects of eating disorders that often go untreated in traditional recovery programs. Our culture creates a working environment of communication, collaboration, compassion, and integrity—all of which are necessary to craft unique treatment plans tailored to our clients’ needs and outcomes.

The Role

As the Utilization Review Specialist at Alsana, you will have a well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. You will be responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data are tracked, evaluated, and reported. Effectively and efficiently manage a diverse workload in a fast-paced, rapidly evolving regulatory environment. You will collaborate with multiple leaders at various levels throughout Alsana including directors, leads, and DoCS, for the purpose of supporting and improving the UR Department.

Responsibilities

Perform Utilization Review - pre-authorization, concurrent and retrospective review as needed for inpatient/or outpatient services and/or predetermination reviews for services or levels of care requiring authorization according to the market requirements and/or policies
Use clinical expertise and payor knowledge to act as a liaison to treatment team members by utilizing open communication
Participate in case conferences, clinical in-services, and other educational opportunities
Maintain all required documentation in the information systems in a timely manner
Review and identify degree of expertise within UR Band Level with NDoUR
Perform all other duties as assigned

Qualifications

Master's degree and licensed in counseling; APC/LPC, LMFT, LMSW/LCSW or Registered Dietitian
Experience in utilization review, case management preferred
Experience in a business / corporate setting or similar environment is preferred
Experience in Eating Disorder’s preferred