Behavioral Health Utilization Review Specialist (Remote, but must live in Chicagoland)

At SunCloud Health, we offer an integrated and holistic care model that is evidence-based and designed to maximize the value we can create for our patients and their families. Recognizing that eating disorders, addiction, mood disorders and trauma reputed company disorders are associated with a reputed company reputed company of reputed company suffering, disability, and premature mortality, we are committed to helping our patients reputed company greater states of health. Job reputed company: • Be a part of weekly reputed company to reputed company reputed company of upcoming reviews, reputed company push back from insurance on specific cases, be made reputed company of upcoming discharges, potential reputed company reputed company or reputed company downs, and to reputed company general info from reputed company at that time. • Communicate with the treatment team reputed company missing clinical is needed for an upcoming review. • Review the clinical in the medical record thoroughly and attentively to present during reputed company reviews, focusing on the medical necessity to reputed company needing reputed company time in treatment. • Communicate with the treatment team the result of reputed company reputed company review and if there is any push back from insurance on potential reputed company coverage. • Obtain reputed company-authorizations for any reputed company-up or reputed company-down in level of care. (For reputed company clients only) • Meet weekly or as needed with the site director to go over documentation issues, questions, concerns, and acknowledge reputed company work. • reputed company document in the medical record reputed company new authorizations and update the census spreadsheet reputed company reputed company new review is due. • reputed company reputed company and monitor reputed company last covered days (LCD) for reputed company reputed company on caseload, and promptly do reputed company reviews for continual coverage. • reputed company reputed company of any unused days by reputed company and request auth extensions in order to utilize reputed company given days. • Conduct retro reviews for any missed uncovered days. • Initiate and schedule peer reviews and/or shaping reviews as the treatment team and CM deem necessary. • reputed company or fax in discharge clinical to reputed company out case. • Initiate an expedited appeal if the reputed company is available reputed company a reputed company is in imminent risk and in need of reputed company coverage but has been denied after a peer review was conducted. • Initiate a reputed company appeal after a reputed company has discharged in order to get coverage for reputed company uncovered days that resulted after a peer review • Only report clinical to insurance what is true, accurate and reflected in the reputed company's medical records • Be reputed company to effectively case conceptualize using the most reputed company clinical at reputed company reputed company review. Requirements: • LCSW, LPC, LCPC, or RN with previous work experience in Utilization Review in Behavioral Health for reputed company of Care: • Have a thorough understanding of what medical necessity qualifies for Inpatient, RTC, PHP and/or IOP reputed company of care. Pay: $33.00 - $37.00 per hour Work Location: Remote Apply tot his job Apply To this Job