Utilization Review Specialist

REM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. 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/Thu/Fri 8:30 AM - 5:00 PM The MENTOR Network is a mission-based organization dedicated to providing high quality services to those we serve. To deliver on our mission, the Network expects every employee to perform their job in accordance with the Company’s mission. 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 regarding service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis. Essential Job Functions Develop plans to accurately measure documentation of services delivered to assure compliance with auditors. Oversee service delivery authorizations and provide quality assurance of service delivery records. Review all service delivery documentation. Analyze the delivery of services and coordination of required service documentation including corresponding billing tickets. Track current and approved Individual Service Plans and correspond with areas of support services and service delivery documentation records. Verify billing tickets/pre-invoices submitted for processing with all required information. Recommend service delivery utilization parameters. Maintain knowledge of updated funding rules and contracts. Notify internal stakeholders of any updated information on service delivery, authorizations, and utilization of services. Maintain organized and complete records and assure quality-focused service delivery method strategies. Monitor the regional office and storage filing systems. Organize records including availability for compliance audit file review. Provide technical assistance to clinical staff in the service areas. Facilitate timely and appropriate service authorization. Monitor strategies. Provide report analysis of actual service deliveries in comparison to authorized service approvals. Direct and supervise clerical and administrative staff, including performance evaluations, scheduling, orientation, and training. Provide feedback on performance evaluations. Conduct scheduling, orientation, and training. Resolve issues and serve as resource. Perform 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 the position responsibilities. Minimum Knowledge And Skills Required By 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 the assistance of a reasonable accommodation to be determined on a case by case basis. 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. #J-18808-Ljbffr