UR Responsibilities
What is the primary responsibility of a Utilization Review Specialist?
Advocating for clients by securing authorizations
What does COWS stand for?
Clinical Opiate Withdrawal Scale
A ritual used to reduce anxiety.
Compulsion
What free program supports recovery for family members?
12-Step Programs
What does the yellow color on the UR Kanban indicate?
A case needing immediate focus
Which method is used for securing treatment approval before services begin?
Precertification
What does CIWA stand for?
Clinical Institute Withdrawal Assessment for Alcohol
A mental process causing disconnection from thoughts or identity.
Dissociation
At what stage does a person recognize the need for change but not act?
Contemplation
What color on the UR Kanban indicates action is needed?
Tiffany Blue
Why is effective communication with facilities important for U.R. Specialists?
To avoid delays in authorizations
What does a score of 5–12 on the COWS indicate?
Mild withdrawal symptoms
What type of hallucination involves hearing voices?
Auditory hallucination
What’s a common challenge in the maintenance stage of recovery?
Relapsing due to cravings
What HCPC code corresponds to Residential Treatment (RTC)?
H0017
How often should U.R. Specialists follow up on outstanding cases?
At least once a week
What is the purpose of the Mental Status Examination (MSE)?
To assess a patient’s psychological functioning
What does the diagnosis F10.20 refer to?
Alcohol use disorder, severe
Why is family therapy recommended in residential treatment?
To support family in understanding the recovery process.
What HCPC code is used for Mental Health Intensive Outpatient?
S9480
What method can be used if a client is discharged before authorization is obtained?
Retrospective Review
Which domain of the MSE includes grooming and appearance?
Appearance
What condition is associated with impaired insight?
Psychosis
What is the main difference between ambulatory and inpatient detox?
Ambulatory detox is provided on an outpatient basis for those with complicated withdrawal symptoms
What REV code is used for Mental Health Partial Hospitalization?
0912