Utilization Review Specialist - Remote

Odyssey House is looking for a Full-Time Utilization Review Specialist.

Summary: Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment, medical care, prevention, and mental health services. Odyssey House continues to receive Best of State awards for our clinical work and has received Top Workplace Awards. Join our amazing team of healthcare professionals today!

Full-Time Benefits:

• $9k per year tuition eligible
• Access to 24/7 EAP program (Employee Assistance Program) for Mental Health support and more!
• Opportunities for paid continuing education/training
• Monthly incentives and awards
• Flexible scheduling
• Casual dress and atmosphere
• Opportunities for bonuses, awards, raises, and promotions
• Incredible health insurance (medical, dental, vision, FSA, long and short-term disability)
• Immediate eligibility to participate in our 403(b)-retirement plan, Employer 100% match up to 5% after 1 year
• 35 paid days off (additional PTO accrual after 1 year)
• EXTRA time off and gift packages for PT and FT staff that stay more than 90 days!
• Sabbatical Program - where we pay you to take a vacation after 5 years of service!
• On-Demand Pay - Get a portion of your paycheck early for hours already worked! (conditions apply)
• UTA free passes available for your work commute

Functions of the Job:

• Track UCE/UR/Insurance Due Dates for all funding and ensure timely submission of all requests.
• Review all UR submissions for medical necessity, make corrections to UR, and submit for approval.
• Provide ongoing training to staff regarding writing to medical necessity or other issues that present during reviewing UMs.
• Resolve funding denials through immediate UR modification and resubmission to minimize loss of days.
• Update Best Notes and UWITS, as needed, to reflect authorized days.
• Generate Reports with due dates, notify staff of changes, and manage staff progress.
• Complete monthly Medicaid check (upload snapshots to Best Notes.)
• Complete “doc-to-doc” calls, as needed, for insurance authorization.
• Communicate with OH billing department to resolve issues.
• Complete all responsibilities in a timely, thorough, and professional manner.
• Demonstrate fluency in ASAM and DSM-V through successful authorization and processing of UMs.
• Other Duties as assigned.