The Utilization Review Lead is responsible for advocating for client’s and treating facilities for time in Detox, Residential, Partial Hospitalization, Intensive Outpatient and Outpatient level of care. This position requires you to consistently follow up on authorizations, documentation and medical necessity to assist in obtaining maximum service for the client.
- Advocate with various insurance companies for authorizations in various levels of care
- Coordinating with treatment providers on documentation, medical need and authorizations
- Respond to inquiries from insurance companies and document accordingly
- Regularly meet with your manager to identify trends and provide overall analysis of continued treatment
- Participate in peer reviews and the appeal process when denials occur