Utilization Review Specialist

Tuerk House is proud to be acknowledged by Newsweek as a top recovery center in Maryland.
as one of “America’s Best Addiction Treatment Centers” for the past two years! Come and join and grow with The Tuerk House team, work in the recently renovated campus and where we just completed a $10.
2 million project that includes a pharmacy and a state-of-the-art café where patients can choose from healthy food options.
It also includes 18 more beds for in-patient detox treatment.
There are currently 40 beds in use, and by the end of 2023, the Tuerk House hopes to have 92 beds in which people can recover comfortably.
Submission of Authorizations.
Pre-cert, Concurrent review for all level of care including: main campus (3.
7WM, 3.
7), Transitional houses (3.
3, 3.
1), outpatient/IOP (2.
5,2.
1) and authorization for mental health services.
Maintains documentation of clinical reviews in Utilization Management Portal (OPTUM).
Sends thorough reviews to OPTUM and Private insurance as appropriate.
Coordinates peer review and notifications, per policy.
Reviews EMR and ASAM documentation, to determine medical necessity, benefit coverage and appropriate level of care.
Collaborates with clinical, nursing and nurse practitioners to discuss issues that require medical interpretation for OPTUM or private insurance providers.
Works closely with Admissions Dept, CSC, OCU, to facilitate and track level of care changes, admissions and discharges.
> Ability to review charts on an ongoing basis in preparation for audits and to ensure compliance.
Demonstrated ability to maintain the client’s right to courtesy and confidentiality.
Consistently observes essential discipline of the program, including reporting to work, Use of sign-in logs, incident logs, reporting to supervisors, punctual attendance at required staff meetings and training sessions, Adherence to standards of dress, language and general deportment required.
Consistently and promptly performs all monitoring as prescribed by Infection Control Policy.
Demonstrated ability to train staff in medication procedures.
Consistently arranges client medical referrals-out according to policy and demonstrates ability to orient clients to procedures for departure and return from appointments.
AA (Associates Degree) or BS (Bachelor’s Degree) required.
Valid Maryland LPN or CMA license required, BLS certified, required.
Ability to learn in-house software.
If Recovering, five (5) years sobriety.
Must be able demonstrate excellent oral and written communication skills.
This position may include weekend and/or evening duties as needed or required.
Requirements of the Job Computer literate Ability to craft professional emails.
Active listening skills and attention to details Expert documentation of medical records Basic data and analytical abilities.
Organizational skills.
Typing and computer skills.
Time-management abilities.
Attention to detail.
Responsibility and professionalism.
Good communication skills, in both English and Spanish fluently Comply with HIPPA/State compliance regulations.