Utilization Review Specialist

 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 (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!