From direct care staff to program managers to clinicians, our employees make a difference every day. Our talented team helps individuals with intellectual and developmental disabilities thrive in the communities they call home. And as part of The MENTOR Network— a national network of local health and human services providers—REM’s employees are part of a growing organization that’s been at the forefront of providing innovative, community-based care for more than 30 years
Utilization Review SpecialistApply Now Job ID 17000N1Z
Utilization Review Specialist
Primary Location: United States-WV-WVMartinsburg
Function:Program Services Coordination/Case Management
REM Community Options
- Proactively develops plans to accurately measure documentation of services delivered to assure compliance with auditors.
- Oversees service delivery authorizations and assurances, recommends service delivery utilization parameters, and provides quality assurance of service delivery records.
- Provides ongoing technical assistance to clinical staff in the service areas of; facilitation of timely and appropriate service authorization, effective monitoring strategies and report analysis of actual service deliveries in comparison to authorized service approvals (type, units, dollars, etc).
- Analyzes the over/under delivery of services, and consistent coordination of required service documentation along with corresponding billing tickets. Maintains organized and complete records and assures quality focused service delivery method strategies.
- Effectively tracks and assures that current and approved Individual Service Plan(s) appropriately correspond and match areas of support services and service delivery documentation records.
- Completes weekly, bi-weekly, and monthly reviews of all service delivery documentation and corresponding billing ticket/pre invoice submitted by program staff for processing; verifies completeness of required information.
- Assures and maintains functional knowledge base and materials related to current and new funding Rules and Contracts, provides updates and information to supervisor and/others specific to impact on service delivery, authorizations, and utilization of services.
- Responsible for establishing and monitoring the regional office and storage filing systems to assure information is organized, complete, and retrievable for compliance audit file reviews.
- Performs other related duties and activities as required.
- High School Diploma or equivalency degree
Founded in 1980, The MENTOR Network is a national network of local human services providers offering an array of quality, community-based services in more than 30 states to adults and children with intellectual and developmental disabilities, brain and spinal cord injuries and other catastrophic injuries and illnesses, and to youth with emotional, behavioral and medically complex challenges as well as their families.