Role Description The Senior Utilization Review Specialist (SURS) provides administrative support and management to Within and clients. Additionally, the URS works collaboratively with insurance companies and clinical staff. - Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care. - Oversee the entire UR process for client journey from admission to discharge. - Complete precertification process and associated documentation. - Audit charts to ensure content reflects medical necessity guidelines. - Ensure continued stay reviews are completed, accurate, and timely. - Assist clinical staff with appeals when necessary. - Provide support to clinical staff around the UR process. - Train new clinical staff on UR process and procedures including documentation of medical necessity. - Provide ongoing training for existing staff on UR and documentation. - Submit initial assessments, continued stay assessments, and payer requested reviews following the established policies and governing regulations. - Communicate with commercial payers per request of payer and Within policy. - Issue complete and concise communications, submitting the critical elements that establish medical necessity. - Follow-up on approval/denial if no reply is received within 12-24 hours by telephone or payer portals. - Document all actions and activities in the case management and billing management systems. - Advise clinical staff on peer review and/or appeals process and provide oversight when necessary. - Communicate with Admissions Specialists and other members of the Clinical team to ensure effective collaboration. - Compile reports and statistics for presentation to the Utilization Review Committee upon request. - Other duties assigned by the supervisor. Qualifications - Experience in a business or health-related field or an equal combination of education and applicable experience within a higher level of care eating disorders setting. - Minimum of 1 year experience performing insurance verification, utilization review or intake assessments in a Residential Treatment Center (RTC), Partial Hospitalization Program (PHP) and/or Intensive Outpatient Program (IOP) environment, eating disorders setting preferred. - Ability to assist in the development and process improvement of obtaining payor authorization and concurrent appeals. - Manages time effectively, setting priorities, and consistently meeting deadlines. - Ability to effectively interact with insurance companies. - Demonstrates initiative and proactive approach to problem resolution. - Can perform well independently and on a team. - Assumes accountability for behaviors consistent with the customer service policy. - Competent in computer based charting, clinical, and non-clinical software programs. - Understands commercial coverage details. - Operates office equipment efficiently. - Demonstrates appropriate judgment and discretion in the UR Coordinator role. Requirements - Must have reliable internet connection. - Must be comfortable operating a computer and smart-phone and navigate applications within macOS and iOS. - Must be comfortable communicating with colleagues via chat, telephone, and video calls. - Must be able to sit for the majority of the shift. - This is a work-from-home position. Work should be performed in a private, quiet space with minimal background noise. Benefits - Competitive compensation package including salary commensurate with experience. - Remote work flexibility with a results-driven culture. - Comprehensive health benefits that reflect our commitment to wellbeing. - The chance to directly transform lives and makes treatment accessible. - Collaborative and innovative work environment with a team passionate about our mission. - Professional development opportunities and support for continued growth.

• Use clinical and coding knowledge for conducting clinically based concurrent and retrospective reviews of inpatient medical records • Evaluate the documentation of clinical services by identifying opportunities for improving the quality of medical record documentation • Facilitate and obtain appropriate physician documentation for clinical conditions or procedures • Participate in ongoing documentation improvement initiatives and education plans

Role Description The CDIS will facilitate modifications to clinical documentation through extensive concurrent chart review and interactions with physicians and other clinicians to ensure: - Accurate documentation of diagnosis and procedures - Reflection of appropriate clinical severity - Clarification of complications and conflicting documentation - Capture of co-morbid conditions The CDIS will complete the majority of concurrent reviews to evaluate selected patient's medical records for overall quality and completeness. Education of physicians, non-physician clinicians, nurses, and coding staff on an ongoing basis regarding: - Documentation opportunities - Coding and reimbursement issues - Relevant quality and performance improvement opportunities Assist team in meeting and exceeding high performing CDI program metrics. Qualifications - Clinical candidates: Licensed as a Registered Nurse with an Associate Degree (ADN) or Bachelor’s degree in Nursing (BSN), or an MD - At least three (3) years of recent acute care nursing experience required. ICU or ED experience preferred. Clinical expertise required. - HIM professional candidates: Credentialed as an RHIA, RHIT, CPC, or CCS and have experience in ICD 10 coding. - At least three (3) years of clinical coding and/or auditing experience in a hospital environment. - Computer PC literacy required. - Must be an excellent communicator, negotiator, and have great organizational skills. - Strong knowledge of clinical documentation guidelines required. - Must be able to work collaboratively and independently. - Must be flexible with responsibilities in order to meet departmental needs. - Must be able to demonstrate initiative and the ability to work in a fast-paced environment with proficiency in multi-tasking and prioritization. - Experience in computerized hospital/health information management systems and software applications are required. Requirements - Utilize extensive knowledge of documentation requirements and guidelines in accordance with Coding Clinic to improve the overall quality and completeness of clinical documentation by performing concurrent stay reviews. - Utilize client technology to track documentation notes and observations, assign Working DRG and calculate Query DRG to reflect the impact of queries initiated, complete query entry for tracking purposes, and complete validation process to ensure diagnosis located in EMR or attained by query are final coded. - Educate internal staff on clinical documentation needs, changes to clinical documentation guidelines, coding and reimbursement issues, and conduct follow-up reviews of clinical documentation to ensure points clarified with the physician have been recorded in the patient’s record. - Follow established workflows and processes developed for Clinical Documentation Integrity, Strategic Source. - Compose and initiate AHIMA compliant queries. - Maintain open communication with coding to discuss DRG assignment, diagnosis, clinical indicators, coding clinics, and guidelines and educating each other on specialty. - Assign Working DRG for Case Management department to view Length of Stay (LOS) of patients. - Participate and provide input regarding CDI program activities, and attendance at routine team meetings. - Maintain current skill set with regard to government regulations, compliance, and reimbursement guidelines. - Expected to keep abreast of new legislation and regulations that affect CDI. - Maintain personal and professional education and growth. - Responsible for maintaining continuing education credits as required by credentialing organization. Benefits - Salary range for this role is from $85,000.00 to $90,000.00, varying based on geographic location, candidate experience, applicable certifications, and skills. Company Description SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other federal, state, or local protected class.

• Plan, develop, and implement clinical documentation education programs for CDI specialists and providers • Develop orientation and onboarding program for CDI team • Educate team members on review functions within CDI program • Create annual education based on coding and documentation updates • Collaborate with healthcare professionals for program goals and documentation • Mentor and train CDI staff • Monitor and evaluate documentation for compliance and accuracy