Job: Utilization Review Specialist

Do you have a passion for helping others? Tully Hill Treatment and Recovery is dedicated to the belief that substance use disorder is a disease – chronic, progressive and above all, treatable. Join the multidisciplinary team of professionals committed to helping patients and families live sober, productive, happy lives, free of addiction and its aftermath. Tully Hill provides challenging and rewarding work for those with the skills and aptitude to work with individuals in their most vulnerable condition.

Tully Hill is accepting applications for experienced professionals to join our team as Utilization Review Specialist. Will be responsible for providing clinical and medical information to insurance companies and third party payers to justify initial admission and continued stay coverage and prevent denial of payment, researching and communicating insurance companies’ treatment requirements to the treatment team, facilitating appeals of patient claims, coordinating with the multi-disciplinary treatment team to ensure appropriate level of care via treatment and care documentation that meets payers’ treatment and care criteria, reviewing medical records for completeness of necessary clinical, nursing and medical information and communicating deficiencies to the treatment team. Will be cross trained to assist in conducting the pre-admission and admission processes by interviewing, screening and evaluating potential patients, obtaining treatment authorization, communicating patient financial responsibilities and documenting pertinent patient information into electronic medical record.

Qualified individual must have the ability to work in a fast-paced environment as part of a multi-disciplinary team. Strong written and verbal communication skills, competency in an electronic medical record and good computer skills required. Current RN or LPN licensure or other NYS QHP certification required. Must ensure quality, timeliness and accuracy of documentation to ensure compliance with CARF standards, NYS OASAS regulations, other applicable State and Federal regulations, referral partner, and insurance contract and reimbursement requirements. Demonstrable knowledge of substance use disorder and 12-step philosophy and commercial health insurance preferred. Previous utilization review / managed care work experience a plus

Tully Hill Treatment and Recovery, a 501c3 not-for profit corporation, is mission driven and follows a business model. Tully Hill offers a high energy, compassionate, professional environment in a beautiful well maintained property. Tully Hill stands on 33 acres in the beautiful setting of the Tully Valley just 15-20 minutes south of Syracuse. Free onsite parking just steps from the entrance! Pay rate is commensurate with experience and education/credentials. Comprehensive benefits package includes health insurance, 401(k) plan, vacation, sick and personal time, paid holidays, company paid short-term disability insurance, voluntary dental insurance, voluntary additional disability insurance and voluntary life insurance.

Salary Range – $27.00-38.00
The salary range is provided in accordance with NYS law and is based on Tully Hill’s good faith belief of what is accurate at the time of posting. Tully Hill considers factors including, but not limited to, the position and associated responsibilities, market and business considerations, as well as the candidate’s education/training, credentials, and work experience.

It is the policy of Tully Hill Corporation to provide equal employment opportunities to all applicants and employees without regard to race, color, citizenship status, religion, sex, sexual orientation, marital status, age, national origin, status as an individual with a disability or as a disabled and/or Vietnam Era veteran or any other legally protected status and to affirmatively seek to advance the principles of equal employment opportunity.