Experienced Utilization Review Specialist Needed!

LOCATION: George Rosenfield Center for Recovery - 13 Hell Gate Circle, Ward's Island, NY 10035OUR 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.MAJOR FUNCTIONS:Under the direction of the Director of Admissions & Utilization Review, the Utilization Review Specialist will coordinate Medicaid Managed Care authorizations and re-authorizations 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. Candidates must understand the various aspects of the managed care system including LOCATDR 3 criteria, behavioral health benefits, precertification, utilization review, peer reviews, discharge reviews, and appeals. Knowledge of substance use and mental health disorder treatments, including assessments, treatment planning, continuing care recommendations, DSM 5 and ICD 10 diagnostic codes, medications, and medicated assisted treatment is required.SPECIFIC DUTIES & RESPONSIBILITIES:Complete utilization review-based documentation and all required updates.Complete utilization, discharge, and peer reviews.Initiate and resolve appeals.Ensure clinical documentation is up to date and complete.Utilize 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 andrevise 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 maintain department tracking systems related to authorizations and communications with clinical team as needed.Attend regularly scheduled staff meetings and case conferences.Attend all required in-service training seminars.Other relevant duties as required.REQUIREMENTS:Master's degree in social work, Counseling, Psychology, Public Health, or a related field preferred. Candidates with a strong educational background will have the opportunity to apply their knowledge in a practical, impactful setting. At least one year of experience in a social service, healthcare insurance, or utilization review role, or five years of progressive responsibility in these fields. This role offers a chance to leverage your experience and grow within a supportive team. -Qualified Health Professional (LCSW, LMSW, LMHC, LMFT preferred) CASAC-T required with the ability to secure CASAC within six months from hire. We support continuous professional development and certification.Familiarity with OASAS regulations preferred. Stay ahead in your field by working with a team that values compliance and excellence.Highly organized with the ability to manage multiple projects and priorities to meet deadlines and revenue goals. Enhance your project management skills in a dynamic environment.Effective oral and written communication skills. Collaborate with a multidisciplinary team and build strong professional relationships. Proficiency with Microsoft Word, Excel, Electronic Health Records, and Outlook programs. Utilize your technical skills to streamline processes and improve efficiency.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 ScheduleLife InsuranceMedical Insurance (Two Plans)Dental and Vision InsuranceAdditional Insurance Coverages (hospitalization, accidental, critical illness coverage)Long-Term & Short-Term DisabilityFlexible Spending Account/Health Reimbursement Account403(b) PlanCorporate Counseling Associates (CCA) EAP benefitAbility Assist Counseling Services (through The Hartford)Commuter BenefitsEducational Assistance ProgramsSpecial shopping discounts through ADP Marketplace and PlumBenefitsRUFit?! Fitness ProgramPet InsuranceLegal AssistanceOptum Financial Service through ConnectYourCareBenefit Advocacy Center through GallagherOdyssey 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.

Created: 2025-04-04