KNOWLEDGE/EXP:RN, LPC, or LMSW/LCSW. Working knowledge of Microsoft Office.
Two years experience of Utilization Management Experience conducting telephonic and electronic reviews. Must possess the ability to clearly and succinctly communicate with medical staff, clinical staff, nursing staff, parents/guardians and other Clarity Staff; high attention to detail, highly organized and ability to work in a high-paced environment with daily time constraints.
SUMMARY: Analyze facility, insurance, governmental, and accrediting agency standards to determine criteria concerning admission, treatment, and length of stay. Abstracts data from records and maintains Utilization Management documentation of reviews with third party payers. Informs Medical and Clinical staff of certification and review dates and any specific questions or concerns of the third party reviewers. Review and assist Medical and Clinical staff with completion of specific forms required by the different third party payers for specific service requests.
