Utilization Review Specialist

About Amity:

Amity Foundation is a safe place where people can change in an environment that fosters trust; where new values can be formed; responsibility developed, and lasting relationships built. Amity is dedicated to the inclusion and habilitation of people marginalized by addiction, homelessness, trauma, criminality, incarceration, poverty, racism, sexism, and violence. Amity is committed to research, development implementation, and dissemination of information regarding community building.

Remembrance, Resolution, Reconciliation, Restoration, Renewal

Job Summary:

As the Utilization Review Specialist, you will contribute to the organization by providing vital support to the community by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective utilization management-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported.

Essential Duties:

· Conducting and Completing Level of Care interviews for new enrolling students. Creating and documenting the progression of care as determined by the DSM V.

· Accurately document the medical necessity and level of care based on evidence-based criteria.

· Submitting appropriate documentation to the home office so that billing can be completed.

· Welcoming and ensuring that students are signing in and reminding them of their scheduled sessions

· Attending workshops, meetings, and training as requested by supervisor.

· May serve as Community Advocate role in addition to job as requested by community leadership.

· Performs other related duties as assigned.

Education and Experience:

Required:

· High School diploma or equivalent

· Training or relevant work experience.

Preferred:

· 3 – 5 years relevant utilization experience.

· Experience with the fundamentals of the Therapeutic Teaching Community.

· Understand of causes, symptoms, and effects of substance abuse.

Certifications or Licenses:

Required:

· Valid AZDPS Fingerprint Clearance card.

· Current valid CPR and First Aid certification.

· CPI (Crisis Prevention Intervention) & ESR (Emergency Service Response) certification.

· Tuberculosis test from health professional.

Skills/Abilities:

· Proficiency with Microsoft Office Suite, Electronic Medical Record, or similar software.

· Excellent organizational skills and attention to detail.

· Excellent written and verbal communication skills.

· Ability to maintain confidential information.

· Ability to operate general office equipment.

· Demonstrates an understanding of human emotions with a high level of empathy.

· Ability to exercise an amount of empathy and understand the importance of role-reversal.

· Demonstrates skill in patience, active listening, and interest in diverse life stories.

· Good verbal and written communication skills with a genuine enthusiasm for helping people.

· Ability to maintain sensitivity and objectively under pressure generated by association with substance abuse students.