AI Strategist (AUS)

At Bluestone, we prioritize our employees and their wellbeing. We provide competitive benefit options to our employees and their families, including domestic partners.

Our Offerings

Starting salary of $60,000.

Comprehensive health and Rx plans, including a flat‑rate option.

Wellness Program & Benefits

Free preventative care.

Generous paid time off and holidays.

50% tuition reduction at Case Western Reserve University for the MSW program.

403(b) retirement plan with employer match.

Pet insurance.

Employer‑paid life insurance and long‑term disability.

Employee Assistance Program.

Support for continuing education and credential renewal.

Ancillary benefits including dental, vision, voluntary life, short‑term disability, hospital indemnity, accident, critical illness.

Flexible Spending Account for health and dependent care.

Position Summary

The Utilization Review (UR) Specialist will independently facilitate clinical reviews as necessary on admission and for continued stay care.

Review the medical record to ensure medical necessity of admission as well as ongoing inpatient and outpatient treatment.

Determine avenues for advocacy on behalf of patients with insurance for utilization of insurance benefits throughout the patient’s treatment. Respond to intake inquiries via phone, fax and email.

Responsibilities

Complete initial, concurrent, and retrospective reviews of patient care in a timely manner to ensure continuous coverage for patients in inpatient treatment.

Initiate, schedule, and participate in peer reviews and expedited appeals between third‑party payers and facilities as needed.

Maintain sophisticated and current knowledge of mental health disorders, including DSM‑V knowledge, ICD‑10 diagnoses and treatment processes.

Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners including the admitting psychiatrist.

Collaborate with treatment team to discuss clinical authorization and quality of care.

Consistent and timely response to emails and other communications relating to utilization review.

Prepare and submit appeals utilizing independent knowledge and expertise.

Familiarity with processing correspondence with adherence to HIPAA guidelines.

Assist with the intake process for Bluestone admissions, including answering phone calls and reviewing faxed or emailed referrals.

Complete all data tracking as needed.

As relevant to scope of practice, complete psychosocial assessments or group treatment services for either inpatient or outpatient admissions.

Qualifications

Experience: 1–2 years related experience required; 3–5 years preferred; 1–2 years in behavioral health utilization review preferred.

Education & Licensure

Social Work, Mental Health/Behavioral Sciences required.

Bachelor’s or Master’s Degree in related field preferred.

Licensure: LSW, LPC, MFT, LISW, LPCC or LMFT required.

Skills

Sensitivity in relating to persons of varying backgrounds and demonstrated ability to work with diverse groups possessing various strengths, aptitudes and abilities.

Ability to perform job responsibilities with a high degree of initiative and independent judgment.

Demonstrated oral and written communication skills and effective interpersonal skills.

Proficiency in using agency computer systems and software as required to perform essential job functions.

Practical and creative problem‑solving skills.

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