Utilization Review Analyst

## Description

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.

**Position Summary**

Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.

This position reports to the Utilization Review Director

**Objectives / Responsibilities**

• Reviews admissions to determine medical necessity and appropriateness of treatment.
• Reviews patient records to obtain justification of treatment.
• Secures necessary data from the clinical team for extended stay reviews.
• Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
• Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
• Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
• Notify clinical teams of need for current documentation.
• Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
• Attend appropriate daily treatment team meeting
• Salary Range: $50-$57/yr

## Qualifications
**Educational Requirements**

• Bachelor’s Degree Preferred

**Competencies**

• **Patient-Centered Approach** – Treat all individuals with **dignity, empathy, and respect**, recognizing that every role contributes to the patient experience.
• **Excellence & Accountability** – Perform all duties with professionalism, following hospital policies to ensure **safety, compliance, and efficiency**.
• **Teamwork & Communication** – Collaborate with colleagues across departments, maintaining a **positive and solution-oriented attitude**.
• **Commitment to Our Mission** – Uphold the hospital’s values and contribute to a culture of **trust, inclusivity, and continuous improvement**.

**Qualifications**

• 3+ years of UR or case management experience in Substance Use /Behavioral Health
• Good communication
• Ability to work independently
• Experience with Microsoft applications
• Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

**Physical Requirements**

• Ability to sit for long periods
• Ability to walk around campus if needed
• Good dexterity, must be able to type
• Use of telephone

**Work Environment**

• Office setting