Utilization Review Specialist

Job Title

Utilization Review Specialist

Job Description

REM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate us all every day. Join us today, and experience a career well lived.

Salary

$40,170.00

Location

Akron (Portage Lakes area)

Schedule

Mon/Tue/Wed/Thur/Fri 8:30 AM - 5:00 PM

Summary

The Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective service utilization to customers. Provides professional oversight of service delivery authorizations and assurances, effective tracking and timely recommendations in regards to service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis.

Essential Job Functions

To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:

• Develops plans to accurately measure documentation of services delivered to assure compliance with auditors
• Oversees service delivery authorizations and provides quality assurances of service delivery records
• Reviews all service delivery documentation
• Analyzes the delivery of services and coordination of required service documentation including corresponding billing tickets
• Tracks current and approved Individual Service Plan and corresponds with areas of support services and service delivery documentation records
• Verifies billing ticket/pre invoices submitted for processing with all required information
• Recommends service delivery utilization parameters
• Maintains knowledge of updated funding Rules and Contracts
• Notifies internal stakeholders for any updated information on service delivery, authorizations, and utilization of services
• Maintains organized and complete records and assures quality focused service delivery method strategies
• Monitors the regional office and storage filing systems
• Organizes records including availability for compliance audit file review
• Provides technical assistance to clinical staff in the service areas
• Facilitates timely and appropriate service authorization
• Monitors strategies
• Provides report analysis of actual service deliveries in comparison to authorized service approvals
• May direct and supervise clerical and administrative staff
• Provides feedback on performance evaluations
• Conducts scheduling, orientation, and training
• Resolves issues and serves as resource
• Performs other related duties and activities as required

Supervisory Responsibilities

May direct and supervise clerical and administrative staff, including performance evaluations, scheduling, orientation, and training. Provides feedback on employee performance and resolves issues within position responsibilities.

Minimum Knowledge and Skills Required by the Job

The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:

Education and Experience:

• Bachelor's degree required
• 1 year minimum work experience in human services required

Certificates, Licenses, and Registrations:

• None

Other Skills and Abilities:

• For Ohio Basic Excel skills and ability to learn the Ohio state billing software

Other Requirements:

• Travel as needed

Physical Requirements:

• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Americans With Disabilities Statement

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodations to be determined on a case by case basis.

Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We've made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S.

As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law.