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Utilization Review Specialist
Job Code:2020-01-001
Department:Performance Improvement
FT/PT Status:Regular Full Time
Salary Minimum60,190
Salary Midpoint75,238
Position Closes:
Open Until Closed

Job Responsibilities & Qualifications:
 Job Summary
The Utilization Review (UR) Specialist, under general supervision, will review medical records for clients under treatment for mental health, substance use, or intellectual and other developmental disabilities. The UR Specialist will assess proper utilization of treatment and support resources, proper case documentation, and medical necessity of treatment and services in relation to federal and state regulations. The UR Specialist will also assess client admission and discharge data and continuing treatment, person-centered plans or for appropriate services and compliance with regulations.

Education/Experience/Minimum Qualifications
• Bachelor’s Degree in Social Work, Psychology, Nursing or closely related human services or science field meeting the QMHP or QDDP requirements.
• Licensed LCSW, LFMT, LPC, licensed psychologist, RN or other licensed, certified clinical positions.
• Three years of previous Utilization Review experience or an equivalent combination of education and experience that would provide the required knowledge and abilities. Previous clinical experience in a behavioral health setting may be reviewed and considered as equivalent experience.
• Prefer experience in a managed care organization.

Job Knowledge
• Knowledge of laws and regulations regarding client rights.
• Knowledge of Medicaid and other public funding rules and requirements.
• Ability to review, understand and analyze appropriateness of treatment and support plans, which include the diagnosis of client behavioral, mental health and/or substance use disorders and/or IDD when compared with federal and state regulations.
• Working knowledge of pharmacology of medications and psychotropic drug treatment.
• Ability to communicate effectively verbally and in writing.
• Ability to analyze clinical data and present findings in report format.
• Ability to understand and apply federal and state regulations governing quality assurance and utilization review.
• Strong analytical skills.
• Ability to work independently.
• Must be comfortable working in a high stress, dynamic work environment.
• Knowledge of medical terminology, the course and progress of mental health, substance use disorders, IDD treatment and supports and clinical terminology. Accesses pertinent other medical expertise as needed to access medical interactions with comorbid conditions impacting MH/SU/IDD.
• Ability to work accurately, independently and with meticulous attention to detail.
• Demonstrated proficiency with MS Office software, including Word, Excel, Outlook and Power Point and other related software.
• Prior experience working with electronic medical records software.