Job Information
ALCOHOL & DRUG ABUSE COUNSIL Insurance Utilization Specialist in San Angelo, Texas
The Insurance Utilization Specialist will be responsible for the following:
Ensuring Medical Necessity:
Case Managers assess whether proposed treatments and procedures are medically necessary based on established guidelines and protocols.
Reviewing Patient Information:
They examine patient medical records, treatment plans, and other relevant information to determine the appropriateness of care.
Types of Reviews:
Prospective Review: Evaluates medical necessity before services are rendered (e.g., prior authorization).
Concurrent Review: Monitors patient care and resource utilization during the course of treatment.
Retrospective Review: Examines the appropriateness of care after services have been provided.
Essential Skills:
Strong communication and interpersonal skills: The ability to effectively communicate with clients, families, and other professionals.
Organizational skills: The ability to manage multiple cases and tasks efficiently.
Problem-solving skills: The ability to identify and address client needs and challenges.
Advocacy skills: The ability to advocate for clients' rights and needs.
Empathy and compassion: The ability to understand and connect with clients on a personal level.
Knowledge of relevant resources and services: Familiarity with community resources and support systems.
Education and/or Experience
Must be outgoing and excellent interpersonal and communication skills. A person in this position must be reliable, dynamic, articulate, flexible, and professional. Bachelors degree preferred.