Job Description

Cenikor's Value Proposition - What's In It for You?

• PURPOSE in your work - service to others, giving back to your community, helping to save lives, being fulfilled at work. See how we served last year.
• COMPETITIVE PAY, BENEFITS, PAID TIME OFF, $2k - $4k TUITION REIMBURSEMENT, up to 10% 401K and BONUSES - we hire and reward high performers.
• Benefits for full-time team members include Medical, Dental, Vision, Basic Life & AD&D, LTD, STD, Accident, Critical Illness, HRA/FSA
• STABILITY and GROWTH - more than 55 years in business - our strong financial processes support our drive to serve more people and ensure stability for our team members.
• CONTINUOUS LEARNING and PROFESSIONAL DEVELOPMENT - we are committed to developing our leaders in their desired career path and promoting from within. We have Cenikor Career Pathways Program that you can join after 90 days of employment. We also have an annual leadership development program with assigned mentors to help you achieve your professional goals. More than 25% of our total employees have been promoted the last 4 years.
• STUDENT LOAN FORGIVENESS - The Public Service Loan Forgiveness (PSLF) forgives your qualified student loans if working for a non-profit for a specific period of time. Find out more here.
• The work we do isn't easy. If you like purposeful hard work, serving others, and having FUN with your team while achieving goals, Cenikor will be the right place for you!

Schedule: Monday - Friday 8am-5pm

ESSENTIAL FUNCTIONS:

• Responsible for knowing and following assigned plans' guidelines, pre-certification requirements and procedures for Third Party Payors, including Medicaid, Medicare, and Insurance.
• Responsible for knowing and following TAC 448, ASAM, TDI Regulations, CARF and other clinical regulatory criteria to obtain treatment/funding authorization for the appropriate level of care.
• Review the insurance verification and complete the authorization process within established time frames. Accurately enters all data and communications into Electronic Health Record.
• Responsible for completing the clinical appropriateness (utilization) review of Detoxification, Residential, Partial Hospitalization, Intensive Outpatient and Outpatient, as required, for appropriateness of admission and patient placement with Third Party Payors.
• Obtain utilization concurrent authorization for continued treatment through discharge and works closely with Clinical staff and/or Facility Director to ensure authorization is obtained for reimbursement of all treatment days.
• Serve as liaison between Facility, Insurance Department and Insurance Company to identify and report authorizations trends per payor denials, appeals, and approvals.
• Review assigned payer sites for policy changes, manual updates and provider bulletins regarding the authorization process and be able to communicate process or payor related changes throughout the foundation.
• Serve as consulting reviewer on challenging clinical cases and statistical outliers that may be denied or sent to peer review due to limited clinical documentation.
• Identify training opportunities for utilization management staff based on authorization review and coordinate training initiatives based on trends throughout the foundation.
• Facilitation of audits and training of clinical staff.
• Coordinate and facilitate ongoing communication with Access Center, Insurance Department, and Facilities concerning patient insurance needs.
• Counsel patients regarding insurance coverage and answer questions about approval and denial of client treatment and/or step-downs in service.
• Interact regularly with insurance carriers to provide accurate information, allowing the carrier to make an informed determination of a patient's coverage/eligibility to obtain reimbursement.
• Ensure standard codes are accurately assigned to clients' medical information for insurance reimbursement purposes.
• Submit written formal appeals based on clinical review of level of care, as needed for approval or denial of authorizations for client's care.
• Maintain record of approval and denial outcomes and communicate with facilities.
• Maintain strict confidentiality on all client and foundation matters and refer questionable issues to supervisor.
• Uphold the core principles of Cenikor's culture and create a positive working environment for all team members.
• Perform additional duties as assigned and consistent with the exempt functions as defined in this job description.

QUALIFICATIONS FOR THE POSITION:

Skills, Knowledge, and Abilities:

• Have strong knowledge of use, abuse, and treatment of illicit drugs and addiction.
• Have the ability to respond to individuals with patience, empathy, and understanding.
• Experience working in a remote healthcare environment.
• Be willing and able to work weekends if necessary or required in crisis situations.
• Possess good time management skills to meet aggressive deadlines and prioritize multiple tasks.
• Experience working with a diverse population.
• Possess excellent organization, oral and written communication skills.
• Possess high attention to detail.
• Knowledge of Microsoft Office software required, including specific MS Outlook calendar experience.
• Ability to consistently uphold the Core Principles of Cenikor's Culture.

Education:

• Master's Degree in Social Work, Human Services, Nursing, or related mental health field required.

• Minimum 5 years of experience in direct care within a chemical dependency or psychiatric facility required.
• Minimum 2 years of experience in crisis intervention and/or case management services required.

Additional Experience:

• One to three years of experience working within Utilization Review.
• Two years of substance abuse treatment experience preferred.
• At least 1 year of experience working directly in utilization review for an inpatient substance abuse treatment facility.

EQUAL OPPORTUNITY EMPLOYER

DRUG FREE WORKPLACE

Job Type: Full-time

People with a criminal record are encouraged to apply

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