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Utilization Review: A Day in The Life

When prospective candidates consider the addiction treatment industry, they are often amazed at how many different job responsibilities exist in a treatment center. Of course, there is management, medical staff and behavioral tech, but other administrative positions, such as utilization review managers, make a huge difference in the continued operation treatment program.

What Is Utilization Review?

Utilization review managers work closely with payers, including insurance companies to ensure fair reimbursement to the facility for the important services being performed. While not always opposing forces, insurance companies want to minimize payouts while treatment centers try to offer the client optimal time to begin their recovery.

While utilization review managers do not necessarily have to be addiction professionals, having the knowledge and firsthand experience of addiction could be extremely useful when communicating to Insurance companies. Why? Treatment for addiction and mental health disorders is a very fluid process that can sometimes become complex and even overwhelming for those who do not know the industry. Being able to speak to their counterparts at the insurance company from a place of knowledge and understanding as it relates to client is of great value. Further, a successful utilization review specialist can maximize the number of days that the patient remains in treatment, thus giving them a better chance of avoiding relapse after treatment.

Typically, the utilization review employee will spend a significant amount of time speaking to representatives at the insurance companies – discussing the client’s circumstance and progress and advocating for there continue treatment. In addition, the utilization review team will work closely with clinician to understand the client’s circumstance and what is needed to achieve the very best outcomes of their treatment.

Utilization Review, HIPAA and Documentation

While utilization review specialists are not on the clinical side of treatment they are still in contact with private and confidential information. That means that all the laws and regulations governing HIPAA also apply to utilization review. Documentation is also critical. Many UR employees find that getting their addiction counselor certification is a very useful way to boost their skills in their existing job as well as opening opportunities for other jobs within the facility.

Utilization review is very valuable to the operation of the facility and often represents a stepping stone to the clinical side of addiction treatment. So, as you take courses is to become an addiction counselor or behavioral tech, consider a utilization review position as a way to broaden your experience in the treatment industry and expand your horizons.