Utilization Review Assistant - Substance Use Disorders

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Utilization Review (UR) Assistant manages and obtains all funding for inpatient clients at the St. Lukes Penn Foundation Inpatient Recovery Center.

JOB DUTIES AND RESPONSIBILITIES:

• Manages the day-to-day insurance and funding reviews for all inpatient clients.

• Performs continued stay and discharge reviews when needed.

• Performs pre-certifications when county funding is changed to insurance.

• Completes case consultations on all inpatient clients within seven days of admission.

• Performs appeals when funding is denied or changed in clients who were Bucks County funded and have changed to Medical Assistance.

• Is the primary link to the St. Lukes Penn Foundation Business Office. Has open communication concerning billing with the Business Office.

• Enters authorization information into the computer system so proper billing can occur.

• Participates in daily morning report gathering information on the clients so reviews can be done. Discusses aftercare planning with counselors to ensure client has proper funding for where they are going.

• Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information.

• Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.

• Demonstrates/models the Networks PCRAFT values during interactions with all customers.

• Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety.

• Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices.

• Complies with Network and departmental policies regarding attendance and dress code.

• Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated.

• Other duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for one to 5 hours per day, 1 hours at a time. Standing for up to 2 hours per day, up to 30 minutes at a time. Walking for up to 30 minutes a day, up to 10 minutes at a time. Frequently uses fingers for typing and writing. Occasionally uses fingers, hands for turning/twisting. Rarely uses the hand for firm grasping. Frequently lifts, carries, pushes and pulls objects up to 10 pounds, occasionally pulls items up to 25 pounds. Frequently stoops, bends, occasionally crouches and reaches above shoulder level. Frequently kneels and squats. Must have the ability to touch as related to telephone and computer keyboard. Must have the ability to hear as it relates to normal conversations and high and low frequencies in person and on the telephone. Has ability for seeing as relates to general vision, peripheral vision and vision monotony. Able to speak clearly as related to communication on the telephone and in person.

EDUCATION:

Undergraduate degree in a Human Services field

TRAINING AND EXPERIENCE:

Minimum of two or more years of health care experience required. Experience in a medical practice operations role preferred. Assessment experience along with experience in communicating with insurance companies and funding sources. Clinical understanding in the provision of AOD clinical services and/or MH services. Ability to work assertively with insurance companies and funding sources. Ability to understand the complexity of the client care and the ability to translate that to our funding sources. Ability to make decisive, clinically appropriate decisions and recommendations that are in the best interest of clients.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.