Utilization Review Specialist

Full-time

Description

The Utilization Review Specialists works on behalf of Behavioral Health facilities assessing patient care plans ensuring its appropriateness to ascertain cost effective treatments, acting as a contact between the facility/provider and insurance carriers.

Primary duties may include but not limited to:

Reviewing Medical Necessity

Authorizations and Approvals

Level of Care Determination

Concurrent and Retrospective Reviews

Communication and Collaboration

Appeals Management

Data Analysis and Reporting

Compliance

Requirements

Requirements (Preferred)

Clinical Knowledge - having a strong understanding of medical terminology, clinical procedures and healthcare practices.

Excellent verbal and written communication skills for interactions with nurses, physicians, insurance representatives etc.

Analytical (ability to interpret data and identify trends), Organizational, Computer and Problem Solving Skills.

Knowledge of the USA Healthcare Regulations such as HIPPA, Medicare, Medicaid, ASAM Levels.

One to three years of experience in utilization review, case management or related field within the Behavioral Health Industry.

Strong attention to detail and ability to adhere to strict confidential guidelines.

Licensed Practical Nurse (LPN ), certification in healthcare administration or equivalent.

If you meet the qualifications and are ready to take the next step in your career, apply today!