medical record specialist Remote
Job description
Lightfully Behavioral Health is a growing leader in mental health treatment providing high-quality, evidence-based treatment and innovative, compassionate care focused on total wellness for those struggling with mental health conditions. Lightfully provides treatment on a full continuum of care including residential, partial hospitalization, intensive outpatient, and virtual services. With current communities providing best-in-class care in Southern California markets, Lightfully is positioned for dynamic and high-paced growth.
Welcome to a behavioral health services company unlike those that have come before it. One where leaders believe in the healing and nourishing quality of compassion both in treating clients and caring for our people. A safe place to bring your whole self to work and infuse a bit of your own magic into what you do every day. The Lightfully Shining Commitments reflect our commitment to these principles and encourages our staff to deliver exceptional performance through their authenticity, bravery, and grit. We believe that great things can happen when we create space for people to light fully.
Job Summary:
The UR Specialist has a well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. They are responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data are tracked, evaluated, and reported. The UR Specialist effectively and efficiently manages a diverse workload in a fast-paced, rapidly evolving regulatory environment. This position collaborates with multiple leaders at various levels throughout the organization, including directors, leads, and DCOs, for the purpose of supporting and improving client care.
Major Responsibilities:
- Manage assigned workload within established performance standards.
- Establish and maintain positive relationships with providers, clients and caregivers through telephonic and / or in-person visits.
- Participate in discharge planning process with facility staff, ensuring adequate and appropriate disposition and post discharge plans.
- Establish positive relationships with treating physicians and other health care providers through collaborative problem solving.
- Perform Utilization Review - pre-authorization, concurrent and retrospective review as needed for residential or outpatient services and/or predetermination reviews for services or levels of care requiring authorization according to the market requirements and/or policies.
- Perform Peer Reviews as appropriate to licensure and insurance provisions.
- Maintain open communication flow with Case Management and program-level staff to facilitate smooth transition and follow-ups as client is transferred from one level of care and/or service to another.
- Maintain all required documentation in the information systems in a timely manner.
- Serve as a resource to program-level teams on medical necessity criteria, discharge types, and peer reviews.
- Perform other tasks as assigned
Specific Skills/Competencies:
- Excellent management and supervisory skills.
- Excellent written and verbal communication skills.
- Excellent organizational and time management skills.
- Proficient in Microsoft Office Suite or similar software.
General Skills and Requirements:
- Able to communicate effectively in English, both verbally and in writing.
- Able to work for prolonged periods sitting at a desk and working on a computer.
Qualifications:
- Masters degree in counseling or related health field, preferred.
- In lieu of masters degree, individual must hold a bachelors degree in a psychology-related field with 2 years of experience in case management and/or utilization review.
This is an exciting opportunity to help us build something from the ground up. To be part of a dynamic team of passionate providers looking to create something exceptional and well timed in the market.
