Utilization Review Specialist at Impresiv Health

• Complete the continuum of utilization review processes, including initiating and completing first level medical necessity review, issuing notifications of approvals, denials, terminations, and reductions, and routing service requests to the behavioral health medical physician. • Provide consistent and sound first level medical necessity review for published authorization strategies, medical policies, review criteria, review standards, and regulatory requirements in the application of the utilization review process. • Review initial, concurrent and post service requests for inpatient, residential and outpatient levels of care. Facilitate discharge planning with facilities and delegate case managers. • Identify behavioral health utilization trends and assist members in receiving appropriate services for identified needs. Perform telephonic care review for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned. • Adhere and understand the interplay regulatory requirements and policies as it relates to behavioral health services and utilization review. Apply, interpret, and communicate policies, procedures, clinical guidelines, medical policy, regulations, and standards. • Provide information to members and providers regarding behavioral health benefits and community treatment resources. • Stay current with behavioral health community resources and service offerings • Meet productivity and quality measures as determined by the department. • Document review activities in accordance with professional licensing board established organizational standards. • Manage the Behavioral Health Triage Line; including include answering crisis calls for members who may need triage and referral to crisis resources. Identify and refer cases that would benefit form care management services.

Heads-up

Utilization Review Specialist

Requirements and responsibilities

Skills wanted:

Language(s) required:

Marcus Fontaine

Former Torrex

About Impresiv Health:

www.impresivhealth.com/

Admin access needed

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