Utilization Review Analyst

Utilization Review Analyst

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.

Position Summary

Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.

This position reports to the Utilization Review Director

Objectives / Responsibilities

• Reviews admissions to determine medical necessity and appropriateness of treatment.
• Reviews patient records to obtain justification of treatment.
• Secures necessary data from the clinical team for extended stay reviews.
• Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
• Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
• Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
• Notify clinical teams of need for current documentation.
• Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
• Attend appropriate daily treatment team meeting
• Salary Range: $50-$57/yr

Qualifications

• Bachelor's Degree Preferred

Competencies

• Patient-Centered Approach Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
• Excellence & Accountability Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
• Teamwork & Communication Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
• Commitment to Our Mission Uphold the hospital's values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications

• 3+ years of UR or case management experience in Substance Use /Behavioral Health
• Good communication
• Ability to work independently
• Experience with Microsoft applications
• Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

Physical Requirements

• Ability to sit for long periods
• Ability to walk around campus if needed
• Good dexterity, must be able to type
• Use of telephone

Work Environment

• Office setting