Utilization Review Assistant

TITLE: Utilization Review Assistant


FLSA CODE: Non-Exempt


PROGRAM: George Rosenfeld Center for Recovery (GRCR)

OUR MISSION:

Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.

If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.

MAJOR FUNCTIONS:

Under the direction of the Coordinator of Utilization Review, the Utilization Review Assistant will provide support with filing, tracking, scheduling, and internal/external communications to the Utilization Review team. Utilization Review Assistant documents all updates on authorizations in the electronic medical record, including communications with insurance companies, requests for clinical updates, denials received, and others as needed. Utilization Review Assistant manages discharges across all 820 programs. Participates in collaborative calls with MCOs to confirm client's engagement in treatment. Assists in managing all work queues assigned to Utilization Review to ensure timely follow up on accounts.

SPECIFIC DUTIES & RESPONSIBILITIES:

1. Manages discharges across all 820 programs; confirm discharge documentation was received and processed accordingly by managed care organizations.
2. Participates in collaborative calls with MCOs to confirm client's engagement in treatment.
3. Uploads admissions LOCADTR, concurrent review LOCADTRs and pertinent UR documentation such as legal mandates, MCO correspondence, and discharge documentation to be filed in the department SharePoint and the electronic health record.
4. Receive, track, and distribute information from MCO case management staff for client's receiving enhanced benefits plans such as HARP.
5. Track and maintain MCO correspondence on SharePoint for intradepartmental use.
6. Retrieves voicemails and faxes for the department and transcribes the information into the team calendar and team SharePoint.
7. Schedule live reviews & peer to peer sessions for Coordinator of UR and relevant parties.
8. Produce UR meeting minutes and distribution to relevant parties.
9. Prepare, file, and submit monthly updates on the progress of identified projects, rosters, retention and reports as needed.
10. Attend regularly scheduled staff meetings and case conferences.
11. Communicates in a positive, professional manner at all times
12. Attend all required in-service training seminars.
13. Other relevant duties as required.

REQUIREMENTS :

1. High School Diploma or GED, with 3 years' experience in an administrative support role in a healthcare setting; Or associate degree in healthcare/Business Administration or Related (Required).
2. Highly organized and ability to manage multiple projects and priorities to meet deadlines and revenue goals.
3. Communicate effectively, both orally and in writing.
4. Ability to work within the context of a multi-disciplinary team, build relationships and foster partnerships.
5. Proficiency with computer operation (Microsoft Word, Excel, Electronic Health Records, and Outlook programs).

In addition, Odyssey House offers our Utilization Review Assistant:

• A 35-hour work week (as opposed to a 40-hour work week)
• Vacation Plan and Holiday Schedule
• Life Insurance
• Medical Insurance (Two Plans)
• Dental and Vision Insurance
• Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
• Long-Term & Short-Term Disability
• Flexible Spending Account/Health Reimbursement Account
• 403(b) Plan
• Corporate Counseling Associates (CCA) EAP benefit
• Ability Assist Counseling Services (through The Hartford)
• Commuter Benefits
• Educational Assistance Programs
• Special shopping discounts through ADP Marketplace and PlumBenefits
• RUFit?! Fitness Program
• Pet Insurance
• Legal Assistance
• Optum Financial Service through ConnectYourCare
• Benefit Advocacy Center through Gallagher

Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.