Utilization Review - UR - Specialist - LPC, LCSW, LMFT
San Marcos, TX
Paid vacation, Paid holidays, Life Insurance, Health Insurance, Dental Insurance, 401K / Retirement plan
San Marcos Treatment Center has an excellent career opportunity for an experienced Utilization Review (UR) Specialist to join our dedicated clinical team.
You must upload a resume complete with your full education and experience in order to be considered for this position.
As the UR Specialist you are responsible for overseeing the development of patient care documentation (MTP/MTPU), tracking certification and continued stays, completing appeals, reducing denials, and increasing length of stay through competent clinically-focused reviews as related to medically necessary criterion.
You must also be able to apply oversight of patient clinical care to short-term commercial managed care, Medicaid/State Agency, and Tricare-funded patients ages 7-18 with psychiatric, neuropsychiatric, or neurodevelopmental issues and their families.
• Knowledge of Utilization Review/Utilization Management in Psychiatric programs.
• Knowledge and practical application of LOCAT criteria utilized by managed care.
• Knowledge of preparation and submittal re: appeals of denials.
• Must have professional license for the state of Texas. You must be in good standing in the healthcare field. Preference will be given to LPC, LCSW, or LMFT.
• Proficient in HIPPA and have the ability to maintain confidentiality of patient, facility and financial information.
• Proficient in compiling clinical reports and demonstrate success securing continued coverage/authorization for patients.
• Must have professional and positive verbal, written and interpersonal skills, excellent computer skills, and the ability to learn new systems.
• Must have strong organizational skills and attention to detail.
• Must have the capacity to understand/demonstrate appropriate and professional boundaries.
• Must have ability to work both independently and as part of a team.
• Must organize and efficiently implement all service as required in the areas of concurrent and retrospective reviews on open and closed cases.
• Must respond appropriately and effectively to exceptional and unusual/non-routine occurrences as they arise.
Founded and in continuous operation since 1940, San Marcos Treatment Center has maintained its core belief in the value of each individual as championed by the Browns more than 70 years ago. We are a provider of intensive psychiatric residential evaluation and treatment, offering services to a unique population of children and adolescents from across the United States and overseas.
We are an Equal Opportunity Employer.