Utilization Review

Gateway Rehab Centers has an exciting opportunity for an Utilization Review position. In this role, you will be responsible for all utilization review and activities related to our Gateway Rehab Center patients with managed care oversite. This position receives infrequent supervision and instruction.  THIS IS A REMOTE POSITION! May require a weekend shift.

Responsibilities

• Gathers clinical information needed for concurrent and retrospective reviews. 
• Completes concurrent and retrospective review process with the payor for treatment. 
• Collaborates with other UR team members and clinical staff in preparation for reviews and/or personal daily schedule.
• Enters daily authorization information into patient database.
• Communicates authorization status to clinical staff.
• Monitors the last covered payment day for patients and alerts appropriate clinical staff.  
• Investigates and resolves problems with incomplete or missing authorizations.
• Identify errors that could negatively impact reimbursement for patient treatment.
• Utilizes resources and collaborates with multiple departments within Gateway Rehab Centers when appropriate, to ensure there is no lapse in coverage. 
• Instructs clinical and support staff on county funded, managed care, and commercial insurance procedures. 
• Completes peer to peer reviews as needed.
• Appropriately alerts of discharge details, when needed for all funding sources.  
• Coordinates with clinical staff to ensure that all funding sources are alerted appropriately with each change of status.
• Investigates denied claims for services provided to recapture payment as needed.
• Attends managed care provider meetings as needed.
• Attends mandatory GRC trainings and in-services.

Knowledge, Skills, and Abilities

• Computer proficiency with working knowledge of Word, Excel, and use of e-mail.
• Excellent verbal and written communication skills and organizational skills.
• Familiarity with drug and alcohol/mental health treatment and/or managed care processes required.
• General understanding of ASAM criteria.  
• Ability to multi-task 
• Excellent time management skills.  

• Bachelor’s Degree or Registered Nurse with current PA licensure.  

Additional Requirements

• Pass PA Criminal Background Check
• Obtain PA Child Abuse and FBI Fingerprinting Clearances
• Pass Drug Screen
• TB Test 

Work Conditions

• Remote - Weekend Shift
• Favorable working conditions.
• Minimal physical demands.
• Mental demands include relying on others to provide information to complete the essential functions of the job, attention to detail, and the ability to problem solve complex issues.

Gateway is an Equal Opportunity Employer M/F/V/D