Utilization Management Specialist
Company: Pinnacle Treatment Centers
Location: Mount Laurel
Posted on: November 26, 2022
Utilization Management Specialist
We offer competitive salary, full benefits package, Paid Time Off,
and opportunities for professional growth.
Pinnacle Treatment Centers is a growing leader in addiction
treatment services. We provide care across the nation touching the
lives of more than 30,000 patients daily.
Our mission is to remove all barriers to recovery and transform
individuals, families, and communities with treatment that
Our employees believe we are creating a better world where lives
and communities are made whole again through comprehensive
As a Utilization Management Specialist II, you are required to work
independently to determine the clinical severity of an illness and
the intensity of the service criteria for a patient receiving care
within our network. You will need to exhibit excellent
communication and documentation skills and work closely with
insurers, accrediting bodies, and other healthcare providers.
Master's Degree in Social Work, Psychology, Counseling, or related
Human Services field is required.
Licensed Clinical Social Worker (LCSW), Licensed Psychologist (LP),
Licensed Professional Counselor (LPC), or Registered Nurse is
required. Licensed Clinical Drug and Alcohol Counselor (LCADC) is
Minimum of five years' experience in the mental health and
substance abuse field required; experience with all target
populations and direct experience performing benefits and/or
utilization management in a managed care setting preferred.
Understand current DSM (Diagnostic and Statistical Manual) and ASAM
(American Society of Addiction Medicine) Medical Necessity Criteria
and demonstrate competence in making mental health and chemical
dependency provisional diagnoses and level of care recommendations
with available information.
Knowledge and background with managed care and insurance
COVID -19 Vaccination / approved exemption status
Maintain high level knowledge of behavioral health utilization
review criteria and best practices including coordination of care
with insurance companies, Medicaid, and other payor sources.
Familiarity with current provider manuals by insurer.
Review with behavioral health companies updated clinical
information on a timely basis for the purpose of utilization
management certification, continued stay, and transition of
Provide telephonic intake and crisis triage, verification of
benefits, provide accurate documentation, scheduling and level of
care determination using medical necessity guidelines.
Oversee daily UR process at designated Recovery Works/Pinnacle
location(s) and take appropriate action when necessary. Close
communication with the facility treatment teams and accountability
to inform leadership of any issues pertaining to complete,
accurate, timely documentation.
Document all certification information received and advise
Administration Department of any insurance problems.
Effectively input all authorization daily into the agency's billing
software/database for applicable Recovery Works/Pinnacle
Process appeals with managed care companies. Ensure documentation
submitted is complete, accurate, and timely.
Participate in multidisciplinary team and Flash meetings for
current clinical status and to maintain consistency in documented
issues in the Electronic Medical Record.
Review hard copy authorizations for potential problems and notify
Assist in case management and transition of care duties as
18 days PTO (Paid Time Off)
401k with company match
Company sponsored ongoing training and certification
Full comprehensive benefits package including medical, dental,
vision, short term disability, long term disability and accident
Substance Use Disorder Treatment and Recovery Loan Repayment
Program (STAR LRP)
Discounted tuition and scholarships through Capella University
Join our team. Join our mission.
5 year(s): Experience in the mental health and substance abuse
Masters or better
Licenses & Certifications
Lic Clinical Social Wrkr
Lic Cert Alc & Drug Coun
Lic Prof Clin Counselor
Functional Expert: Considered a thought leader on a subject
Team Player: Works well as a member of a group
Dedicated: Devoted to a task or purpose with loyalty or
Self-Starter: Inspired to perform without outside help
Ability to Make an Impact: Inspired to perform well by the ability
to contribute to the success of a project or the organization
Pinnacle Treatment Centers is an equal employment opportunity
employer and makes employment decisions based on merit and other
legitimate business considerations. We want to have the best
available persons in every job. Company policy prohibits unlawful
discrimination based on race, traits historically associated with
race, color, creed, religion, sex (including pregnancy, childbirth
or related medical conditions), parental leave, national origin,
gender, gender identity, gender expression, age, ancestry, physical
or mental disability, military and veteran status, marital status,
sexual orientation, genetic characteristics or information,
political affiliation, non-merit based factors or any other
consideration made unlawful by applicable federal, state, or local
laws. It also prohibits discrimination based on the perception that
anyone has any of those characteristics or is associated with a
person who has or is perceived as having any of those
Keywords: Pinnacle Treatment Centers, Philadelphia , Utilization Management Specialist, Executive , Mount Laurel, Pennsylvania
Didn't find what you're looking for? Search again!