Behavioral Healthcare Utilization Review Spec

Hours: full-time (37.5 hours per week) Location: Lynchburg VA, 24501 Compensation dependent on experience **Position Summary** The Behavioral Healthcare Utilization Review Specialist works on-site, and will proactively monitor utilization of services for clients, reviewing for quality of services and medical necessity. The employee will review clients’ medical records to ensure appropriate utilization of treatment resources, medical necessity, proper documentation, and compliance with federal and state regulations, and certification requirements of insurance plans or other managed care organizations (MCOs). This position will report to the CQI Manager. **Education Requirements** - Bachelor's degree from an accredited college/university in an applicable human services field. Preferred: Master’s degree in social work, Mental Health Counseling, or related health field preferred. **Types of Experience** - (2) Two years of continuous quality improvement and/or utilization review experience. Preference will be given to individual with at least one year of managed care experience. Behavioral Health experience is desirable. - An equivalent combination of education and experience that provides the candidate with the required knowledge, skills and abilities may be considered. **Related Knowledge, Skills and Abilities** - Knowledge of behavioral healthcare terminology, the course and progress of substance abuse treatment and medical terminology; - Knowledge of Medicaid and MCO regulations and policies, relevant to behavioral healthcare and substance use; - Knowledge of Utilization Review protocols and auditing skills; - Knowledge of DSM 5, CPT Codes and ICD 10; - Knowledge of levels of care and medical necessity; - Ability to review and understand medical records, treatment plans and progress notes; - Proficiency in MS Office software and EMR systems; - Ability to extract and analyze data; - Ability to develop and present statistical and narrative reports; - Must be proficient in MS Office software and EMR systems. - Able to collaborate with all members of clinical team/medical providers; - Excellent verbal and written communication skills; - Ability to work independently as well as with a team; - Excellent organizational and time management skills; - Willing and available to work modified schedules (weekends, holiday, etc.) as required; - Ability to drive and must possess a valid driver's license. May be required to travel to different Horizon worksites during the day based on operational needs or provide admin support at other locations. Regular attendance at trainings and Horizon meetings may require travel to a variety of Horizon sites. **THE BEST BENEFITS FOR THOSE WHO TAKE CARE OF THE COMMUNITY** We’re proud to offer some of the best benefits options in Central Virginia. Participation in the Virginia Retirement System (VRS) is exclusively for public service workers in Virginia, while several options exist for life, health, dental, and vision insurance. Emphasis on work-life balance means a generous annual leave policy ensuring time for wellness with separate time allocated for sick leave and additionally for paid holidays. Stay active with Horizon’s annual wellness programs and various opportunities to interact with the community through the year. Horizon’s clinical sites are NHSC/HRSA approved for clinical student loan repayment and qualify for both the Public Service Loan Forgiveness (PSLF) and the Behavioral Health State Loan Repayment (BHLRP) programs. If you are interested in continuing your education, working at Horizon qualifies you to receive discounts at some local universities. **To Apply – Please visit our online career center at** [**https://www.horizonbh.org/careers/**](https://www.horizonbh.org/careers/) Horizon Behavioral Health is an Equal Opportunity Employer (EOE).