Utilization Review Technician jobs in Wisconsin

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Senior Mental Health Counselor (Utilization Review & Benefit Verification)
  • Waukesha County Human Resources
  • Waukesha, WI FULL_TIME
  • Description

    Waukesha County's Department of Health and Human Services is recruiting for a talented individual to perform utilization review and be an intake specialist at the Waukesha County Mental Health Center and Crisis Resource Center. In this role you will be the first point of contact for patients, and you can expect to:

    • Complete routine, frontline administrative work necessary- working with patients to complete all necessary forms, gathering demographic and insurance information, obtaining prior authorizations, entering information into the medical records system, and communicating with others to ensure patient insurance is set up appropriately in the electronic record and billing system.
    • Obtain prior authorizations and continued stay authorizations.
    • Collaborate with internal and external stakeholders to support the patient and ensure high-quality, cost-effective care.
    • Use nationally recognized, evidence-based guidelines to review appropriateness of admission and provision of care based on the patient's clinical condition(s).
    • Communicate with insurance companies and/or payer to obtain admission authorization and continued stay certification or recertification in a professional and timely manner.
    • Document utilization reviews and payer contact communication outcomes.
    • Evaluate and facilitate concurrent and retrospective prior authorization denials, appeals, or payment issues until resolved to ensure proper reimbursement is received.
    • Provide recommendations to providers and works with the healthcare team to ensure proper documentation utilization of care and to support medical necessity for hospital stay in the electronic medical record in accordance with regulatory standards.
    • Serve as a resource to medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations, and documentation improvement opportunities.
    • Communicate payer issues and medical necessity concerns with healthcare team to ensure appropriate care is provided.
    • Identify and escalate trends with insurance companies, denials, documentation/order requirements, or medical necessity concerns. Identifies and escalates quality concerns related to clinical care to leadership as appropriate.
    • Actively contribute to and participates in utilization review and fiscal meetings or committees as assigned.
    • Assists patients with referrals to the Moraine Lakes Consortium, or to the appropriate staff for insurance coverage.
    This position requires the ability to change focus at a moment's notice as necessary, therefore patience, professionalism, empathy, and multi-tasking skills are required. Previous mental health, prior authorization, and utilization review management knowledge and experience is necessary along with the ability to type at least 40 Words per minute.

    This is an in-office position with scheduled hours of 8:00 am-4:30 pm. Casual work attire is allowed and in-office events are held throughout the year.

    Waukesha County offers a comprehensive compensation and benefits package including excellent health/dental/vision, life insurance, generous paid time off (vacation, 10 holidays, 3 floating holidays, ample accrued sick time that rolls over each year), an exceptional pension plan with employer match and lifetime retirement payment plus an optional tax advantaged 457 retirement savings plan. Amongst many other benefits, employees are recognized and valued through a pay for performance system. Successful candidates will be eligible for performance-based merit increases and non-base performance awards. Employee well-being is promoted through a balanced work-life culture and through an exceptional employee wellness program that offers a variety of programs and tools to help promote an employee's wellness and health, including an on-site health & wellness clinic.

    Prior to hiring, the successful candidate will be subject to work/education/certification reference(s) verification, a criminal background and driver's license check.
    Example of Duties

    Under supervision, to perform senior level professional work involving the delivery of mental health services to individuals in need of counseling and/or case management services; and to perform other duties as required.

    1. Receives referrals of clients in need of mental health services. performs intake, and monitors client's behavior in relation to treatment plan goals and client's needs.
    2. Maintains a caseload of individuals with personal social behavior problems including severe mental illness.
    3. Responds appropriately to mental health emergency situations and utilizes crisis intervention techniques and procedures.
    4. May screen requests for mental health services, determine appropriate services for client, and refer as necessary.
    5. May perform medical necessity review that can include assessing appropriateness of treatment setting benefits advisory, prior authorizations, retro authorizations, and continuation of services advocacy.
    6. Provides counseling and supportive therapy to clients individually and/or in a group setting.
    7. Provides case management services, coordinating services with various agencies including public and private payors and benefit entities in order to ensure on?going assessment and follow?through of treatment plans.
    8. Maintains appropriate documentation of all client contacts, consultation with other professionals, and documents any changes on treatment plan; intervenes when appropriate in response to changes.
    9. Participates in various meetings, staffings, and in?services; may provide consultation to other professionals and paraprofessionals.
    10. Conducts assessments of client needs through interviews, collateral contacts, and other investigations; develops a casework plan with clients.
    11. Provides information to family regarding a client's diagnosis and treatment and provides supportive counseling to family as needed.
    12. Acts as a departmental liaison, providing casework direction, and supervision to providers of contracted services.
    13. Provides recommendations and testimony in court as to clients' mental health status and submits appropriate documentation.
    14. Establishes and maintains effective working relationships with clients and their families, service providers, colleagues, payors, benefit entities, and the general public.
    15. Prepares and presents detailed oral and written reports.
    16. Documents case assessment, treatment planning, and progress notes in the written record.
    17. Complies with State and Federal program requirements.
    18. Provides payer services; reviews and verifies all contracted service provider invoicing.
    19. Performs emergency government duties as assigned in event of Waukesha County Emergency Government declaration.
    20. Performs other duties as required.

    QUALIFICATIONS
    Essential Knowledge and Abilities

    1. Considerable knowledge of mental health disorders and treatment methods.
    2. Considerable knowledge of case management principles and methods.
    3. Considerable knowledge of the principles, practices, methods, and techniques used in the treatment of mental health disorders.
    4. Considerable knowledge of human services and health resources in the community.
    5. Considerable knowledge of Wisconsin State Statutes Chapters 51, 54, 55.
    6. Working knowledge of techniques to identify clients with substance use problems.
    7. Working knowledge of electronic health record, computerized department program software, internet access, database, spreadsheet, and word processing programs.
    8. Working knowledge of confidentiality statutes and requirements, including the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
    9. Working knowledge of public and private payor contracts, benefits, authorization requirements, and clinical criteria in relation to clinical programs.
    10. Ability to utilize word processing, database, and spreadsheet programs.
    11. Ability to establish and maintain effective working relationships with clients and their families, service providers, colleagues, payors, benefit entities, and the general public.
    12. Ability to effectively interact with sensitivity with persons from diverse cultural, socioeconomic, educational, racial, ethnic, and professional backgrounds, and persons of all ages and lifestyles.
    13. Ability to respond appropriately to mental health emergency situations and procedures.
    14. Ability to communicate effectively, orally, and in writing.
    15. Ability to communicate with clients who have mental health disorders.
    16. Ability to interpret mental illness and its diagnosis and treatment to clients and families.
    17. Ability to provide skilled treatment to clients with social and behavioral problems.
    18. Considerable knowledge with regard to assessing client risk.
    Minimum Qualifications

    You must meet these minimum Training and Experience requirements:

    1. For work assignments in utilization review and benefit verification the following may be substituted:
      a. Bachelor's degree from a recognized college or university with a major in sociology, social work, psychology, or a closely related field.
      OR
      Graduation from a recognized nursing program with active Registered Nurse licensure.
      b. Two years of full-time experience in a health or human service field.

    Supplemental Information

    About Us:
    Waukesha County prides itself on operating in a business-like manner and is recognized as a leader delivering high quality services with competence and skill. With our vision of "Leading the Way", we value teamwork and collaboration, ethics and diversity, communication, efficiency and cost savings, innovation, and the wellbeing of our staff and the citizens we serve. Employees are provided professional development opportunities and encouragement to learn and practice continuous improvement and LEAN principles as we regularly ask ourselves "Is there a better way?"

    Location:
    Located in the City of Waukesha, our campus offers an on-site cafe and fitness center, free parking, and easy access to interstate highway systems. Waukesha County offers a perfect blend of urban and rural living where one can enjoy the benefits of quiet rural lake communities or opt for nearby attractions that the greater Milwaukee area offers including vast beach and park systems, public markets, performing arts, music festivals, and sports including the Milwaukee Admirals, Brewers, Bucks, Wave, Marquette University Golden Eagles and the UW-Milwaukee Panthers Basketball programs.

    EEO/AA:
    Waukesha County is committed to equal opportunity and nondiscrimination in employment and adheres to all Federal, State and County Equal Employment Opportunity laws, policies, plans, rules, regulations and ordinances. The County recognizes and accepts its important leadership role in providing for equal employment/service opportunities for minorities, women, and persons with disabilities. It is the express policy of Waukesha County to promote equal employment opportunity among all who are employed by Waukesha County and who seek employment with Waukesha County.

    For further information visit:
    The County does not sponsor applicants for work visas.
    Applicants must be currently authorized to work in the United States on a full-time basis.

     

  • Just Posted

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Senior Mental Health Counselor (Utilization Review & Benefit Verification)
  • Waukesha County
  • Waukesha, WI FULL_TIME
  • Waukesha County's Department of Health and Human Services is recruiting for a talented individual to perform utilization review and be an intake specialist at the Waukesha County Mental Health Center ...
  • 1 Day Ago

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Wisconsin is bordered by the Montreal River; Lake Superior and Michigan to the north; by Lake Michigan to the east; by Illinois to the south; and by Iowa to the southwest and Minnesota to the northwest. A border dispute with Michigan was settled by two cases, both Wisconsin v. Michigan, in 1934 and 1935. The state's boundaries include the Mississippi River and St. Croix River in the west, and the Menominee River in the northeast. With its location between the Great Lakes and the Mississippi River, Wisconsin is home to a wide variety of geographical features. The state is divided into five dist...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$61,824 to $86,267

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Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
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