Utilization Review Coordinator - October Road Inc.

Summary:

Pyramid Healthcare is seeking qualified candidates for our Utilization Review Behavioral Health role! The candidate will serve as a floater, supporting the UR team with multiple level of care authorizations for mental health, eating disorder, and substance use disorder treatment.

The hours for this position are Sunday - Thursday 8:30am-5pm EST. This is a fully remote position and all equipment will be provided. Must have knowledge of utilization review and ASAM as a requirement. Employer will provide technology to support role. Must have own high speed internet access.

Essential Duties and Responsibilities:

• Perform admission (pre-certification), continued stay, and discharge reviews on all clients.
• Describe and communicate clearly and effectively the managed care benefits for clients being provided treatment.
• Attending weekly team meeting.
• Maintain positive relationships with referral sources and insurance companies.
• Track admissions, continued stay and discharge requirements for all referrals.
• Maintain daily UR database
• Communicate clearly and effectively with clinical staff to obtain information for client reviews.
• Ensure clients are getting approved for clinically appropriate length of stay
• Expected to provide coverage for other UR team members
• Complete Single Case Agreements as needed
• Ensure UR documentation is completed accurately and in timely manner in electronic health record
• Able to provide case conceptualizations to insurance providers
• Address claims and appeals in a timely manner in collaboration with Director of UR.
• Other duties as assigned.

Job-related Behavioral Characteristics:
Demonstrates professionalism, leadership, confidentiality, strong social communication skills, time-management, organized. Must possess skills to communicate effectively and interact well with people of diverse backgrounds. Excellent oral and written communication and interpersonal skills. Ability to problem solve by gathering and analyzing information, working well in an individual/ group problem solving situation, and showing initiative in problem solving. Maintains professionalism and does not show favoritism. Maintains consistency with clients, staff, visitors, and the public. Ability to handle a crisis situation and react appropriately. Flexibility and adaptable. Ability to make decisions in an objective and ethical manner. Calm and decisive in crisis situations. Ability to sustain a team environment, drive continuous improvement projects, confidentiality, excellent problem-solving skills and excellent communicator within the team framework.

Total Rewards:

• Medical, Dental, and Vision Insurance
• Flexible Spending Accounts
• Life Insurance
• Paid Time Off
• 401(k) with Company Match
• Tuition Reimbursement
• Employee Recognition Programs
• Referral Bonus opportunities
• And More!

Pyramid CORE Values:

We are committed and proud to live our CORE values and use them to inspire those around us. Our employees are expected to align with these values, behaviors and standards. We are held accountable for upholding these CORE Values: INTEGRITY is striving to be honest, transparent and ethical when dealing with clients, staff and the community. DEDICATION is demonstrating an unwavering commitment to always provide exceptional care and support to those we serve is needed daily. COLLABORATION is a steadfast, team-focused approach; working together to achieve excellence. PASSION is genuine, compelling and relentless desire to improve lives and support Pyramid Healthcare’s mission.

Want to know more?

To learn more about Pyramid Healthcare, and how you can achieve personal and professional growth, visit us at: https://bit.ly/Pyramid-Careers.

Pyramid Healthcare, Inc. is proud of its diverse workforce, and is an Equal Opportunity Employer.