Our Mission

Since 1967, Odyssey House has gone beyond helping individuals beat drugs and alcohol. We help rebuild lives. There’s more to recovery than just getting clean. We help individuals get healthy again, too, with medical and dental care, fitness programs, support for your mental health and more. Individuals can stay with their children while in treatment, while learning new life skills, so they can stay together and repair other broken relationships in their lives. We provide educational and work skill trainings, outpatient services and available housing assistance, so individuals can step back into real life with a real future.

If that sounds different than other treatment programs, you’re right. Because Odyssey is where recovery gets real.

In Addition To Competitive Salaries, Odyssey House Offers

A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Pet Insurance
Legal Assistance
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher

Salary Compensation Range: $60,000.00-70,000.00

Major Functions

Under the direction of the Director of Admissions & Director of Utilization Review, the Utilization Review Specialist will coordinate Medicaid Managed Care benefits and approvals for clients receiving behavioral healthcare services from Odyssey House’s Part 820 residential programs.

The Utilization Review Specialist will monitor claims and approvals, and coordinate internally and externally, to ensure uninterrupted service provision. This position is responsible for all verbal and written documentation as required by payers.

Specific Duties & Responsibilities

Complete assessment and pre-certifications.
Complete utilization, discharge, and peer reviews.
Initiate and resolve appeals.
Ensure clinical documentation is up to date and complete.
Utilizes the Concurrent Review/LOCATDR 3 to identify and advocate for appropriate level of care placement.
Ensure that both effective utilization review management and client experience standards are maintained.
Monitor concurrent and retro-review status.
Help assess and implement systems and protocols to improve the utilization process.
Meet regularly with multi-disciplinary team members concerning consumer and program issues; assists in development or modification of procedures for improvement of services.
Stay abreast of new developments in the field of Quality Assurance/Improvement as related to substance use disorder and mental health treatment, recommend new policies and revise existing policies/procedures for compliance with all applicable laws and standards.
Assist with training on relevant topics to management team, clinical staff, and other relevant GRCR staff.
Prepare, file, and submit monthly progress, rosters, retention and reports as needed.
Attend regularly scheduled staff meetings and case conferences.
Attend all required in-service training seminars.
Other relevant duties as required.

REQUIREMENTS: EDUCATION/TRAINING AND EXPERIENCE KNOWLEDGE, SKILLS AND ABILITIES

Bachelor's Degree in Social Work or related field and 5 years employment with progressive responsibility in a social service, health care or utilization review role required OR
Master’s Degree in Social Work, Counseling, Psychology, Public Health, etc. with one (1) year experience working in a social service, health care insurance or utilization review role preferred.
Qualified Health Professional (LCSW, LMSW, LMHC, LMFT, CASAC, CRC) highly preferred.
Knowledge of substance use and mental health disorder treatments, including:
Assessments
Treatment planning
Continuing care recommendations
DSM V and ICD 10 diagnostic codes
Medications and medicated assisted treatment
Must understand the various aspects of the managed care system including:
LOCATDR 3 criteria
Behavioral health benefits
Precertification
Utilization review
Peer reviews
Discharge reviews
Appeals and claims process
Knowledge of OASAS regulations preferred.
Highly organized and ability to manage multiple projects and priorities in order to meet deadlines and revenue goals.
Communicate effectively, both orally and in writing.
Ability to work within the context of a multi-disciplinary team, build relationships and foster partnerships.
Proficiency with computer operation (Microsoft Word, Excel, Electronic Health Records, and Outlook programs).

Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.

Odyssey House jobs

Utilization Review Specialist