Utilization Review Technician jobs in Fresno, CA

Utilization Review Specialist and Intake Coordinator Job Description

• Conduct thorough reviews of client treatment plans to ensure alignment with established clinical guidelines, insurance requirements, and regulatory standards.
• Collaborate with the clinical team to gather and analyze relevant information for utilization review purposes, including treatment progress, goals, and discharge plans.
• Communicate with insurance providers to obtain authorization for treatment services and facilitate ongoing communication regarding the status of clients' treatment.
• Review and interpret insurance policies to determine coverage limitations and exclusions, providing guidance to both the clinical team and clients on potential financial responsibilities.
• Collaborate with the admissions team to assess the appropriateness of admission and continued stay, ensuring that treatment services meet medical necessity criteria.
• Maintain accurate and up-to-date records of all utilization review activities, including documentation of communications with insurance providers, decisions made, and any additional required information.
• Participate in regular meetings with the clinical and administrative teams to discuss individual cases, identify potential issues, and contribute to the development of effective treatment plans.
• Stay informed about changes in insurance regulations, policies, and procedures, and provide training to staff on utilization review best practices.
• Work closely with billing and finance departments to resolve any issues related to claims, denials, or reimbursement for services rendered.
• Ensure compliance with all relevant legal and ethical standards, including privacy and confidentiality requirements.
• Document Clinical duties and observations and directed by the Clinical Director
• Supports to remove logistical barriers to admissions
• Supports the CRM data by tracking leads, admissions, and discharges
• Develops a plan for resident arrival for intake in a timely manner
• Handles the client during entire intake process during transition from once decision made to admit to MTR to their care being handled by their case manager. 
• Maintain resident Electronic Health Records (EHR) documents in the resident file

This Utilization Review and Intake Specialist position is versatile, and the duties may change from day to day in this fast-paced environment!  The ideal Intake coordinator and Case Manager candidate will be able to:

• Provide quality counseling care in a dual diagnosis program
• Build rapport with residents, families, and community referents
• Perform data entry
• Obey HIPAA
• Abide by ethical codes of the APA and CCAPP

 Competencies and Abilities

• Able to build rapport with residents, families, and community referents
• Able to brand, promote, market, and sell treatment services to prospects
• Able to track leads, admissions, and discharges
• Able to manage an outreach budget and expense report
• Able to travel for outreach
• Able to do data entry for face-to-face meetings
• Able to follow up with leads, families, and referents
• Able to provide education on the services and activities offered
• Able to refer out
• Able to do a screening for treatment
• Able to discuss finances
• Able to arrange for travel
• Able to obey HIPAA
• Abide by ethical codes of the APA and CCAPP

Qualifications

• Current CPR and First Aid Certification on file
• Current TB skin test and health screen report
• Completion of an approved 9-hour RADT Orientation Course consisting of ethics, professional boundaries, and confidentiality or proof of equivalent training/experience.

Knowledge

• Twelve Step Recovery Program
• Social Model detox
• Sales strategies
• Community resources and referral techniques
• Data Entry
• Working with addiction and dual diagnosis
• Knowledge shall include the signs and symptoms of alcohol and other drug intoxication and withdrawal.  The handling of medical consultations and referrals shall be a necessity for emergencies.

Skills

• Good listener and building rapport
• Good with data entry
• Good with relationships
• Good with screening for services