Utilization Review Manager - Home Care jobs in Knoxville, TN

We’re looking for people who are excited to join our passionate, authentic, and courageous team. We’re uncompromising in the pursuit of excellence: our core values are more than just words on a page - we live and breathe them. To work at Landmark Recovery is to make a promise to help our patients achieve their wildest dreams. Our mission is to unlock human potential and save a million lives over the next hundred years.

Landmark Recovery operates Residential Treatment Programs for individuals with Substance Abuse Disorder. We seek not merely to restore sobriety, but to transform our patients’ worlds from a state of everlasting darkness to vibrant technicolor. We believe that treatment is local, individualized, holistic and relational. We’re currently in several states and are rapidly growing nationally. Learn more at https://landmarkrecovery.com/.

We’re always looking for people that raise the bar. Learn more about the bar here…

https://landmarkrecovery.com/wp-content/uploads/2023/03/2023.03.14-The-Bar-.pdf

Summary

Associate Utilization Review Coordinators will perform all functions of utilization review. The coordinator functions as a clinical liaison between payers and facilities, providing information and feedback to assist in optimum patient care reimbursement. Associate Utilization Review Coordinators collaborate and partner with Revenue Cycle Management to ensure all steps in the process are managed effectively.

Responsibilities:

• Ensure all provided care is authorized within contractual timelines
• Initiate Precertification for patients entering a Landmark Recovery program applying clinical knowledge
• Conduct Concurrent Reviews on patients being treated and ensures documentation meets insurance requirements for level of care
• Track patients across Landmark’s locations to ensure timely and accurate billing
• Implement Quality Control to ensure cohesiveness by communicating effectively with the treatment teams
• Work with Medicaid facilities to obtain authorization for patients to receive treatment
• Lead retroactive appeals to obtain authorization for patients discharged
• Partner with other members of the Revenue Cycle Management Department to resolve all pertinent issues

Experience:

• Bachelor’s Degree in behavioral health or related field required
• 1-2 years of professional clinical experience
• Clinical License preferred
• Familiarity with SharePoint and Excel
• Proficient in Microsoft Office