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Utilization Review Clinician

VMS-Admin, Durham, North Carolina, United States of America Req #270
Thursday, February 28, 2019
About Veritas Collaborative

Veritas Collaborative is a specialty hospital system for the treatment of eating disorders. Providing a range of services for individuals of all ages, we offer inpatient, acute residential, partial hospitalization, intensive outpatient, and outpatient levels of care. Each patient’s care is individualized, evidence-based, and delivered in a gender-diverse and inclusive environment. Multidisciplinary treatment teams – made up of highly dedicated physicians, psychiatrists, dietitians, culinary professionals, therapists, nurses, education coordinators, administrative professionals, and skilled therapeutic assistants – aim to equip each patient and family with skills to continue recovery in the home environment.

Our Culture

We are a growing, mission-driven organization with a singular vision: a world in which all persons with eating disorders and their families have access to best-practice care and hold hope for a cure.

We expect a lot out of our employees; that’s why we hire people who share our passion for leaving the world a better a place than we found it. If you find yourself drawn to a stimulating, innovative environment, you’ll be happy you chose to work at Veritas Collaborative. We share a common belief that eating disorders are lethal, but they don’t have to be.

Join us, and help us save lives.

The Veritas Utilization Review Clinician analyses patient records to determine legitimacy of ongoing treatment and length of stay in healthcare facility to comply with government and insurance company reimbursement policies by performing the following duties personally or through subordinate supervisors.   ompares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to communicate legitimacy of treatment and length of stay with third-party payers. Abstracts data from records. Administers and reviews appeals, coordinating with treatment team, therapists, and medical doctors in a timely manner.

The Utilization Review Clinician does peer-to-peer reviews with insurance and doctors in order to understand and analyze individual patients’ clinical needs, levels, and progress in treatment. Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment. Uphold clinical standards and ethics of facility, insurance regulations, accrediting agencies, and state and federal laws and mandates concerning admissions, treatment and length of stay of patients with eating disorders.

The Utilization Review Clinician maintain up-to-date expertise and knowledge of healthcare insurance laws, rules, regulations, and developments necessary for the organization to make informed business decisions.

 

Utilization Review Clinician Education and Experience:
 

·         Bachelor's Degree Required. Masters Degree preferred in Clinical Mental Health Discipline (i.e., Clinical Social Work, Clinical Psychology, Counseling Psychology).

·         CEDS Preferred

·         Active licensure in LCSW, PhD, PsyD, LMFT, or LPC in the state providing care (or state-eligible), preferred.

·         Two years’ experience working in mental health in a Joint Commission accredited facility.

·         Eating disorders experience preferred.

·         Previous utilization review experience preferred.

 

Veritas Collaborative is a growing, mission-driven organization with a singular vision: a world in which all persons with eating disorders and their families have access to best-practice care and hold hope for a cure. We expect a lot out of our Utilization Review Clinician ; that’s why we hire people who share our passion for leaving the world a better a place than we found it. If you find yourself drawn to a stimulating, innovative environment, you’ll be happy you chose to work at Veritas Collaborative. We share a common belief that eating disorders are lethal, but they don’t have to be.

At Veritas Collaborative, all full-time employees are eligible for benefits, including: Medical, Dental, Vision, Disability, Paid-Time Off and 401(k).

Other details

  • Pay Type Salary
  • VMS-Admin, Durham, North Carolina, United States of America