Utilization Review (UR) Appeals Specialist

Job Address:

UR Appeals Specialist

Shift: M-Fr 8-5

Who we are

At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment.  We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.

The Role Itself 

Position Summary: The Utilization Review Appeals Specialist is responsible for the appeals of denied claims for Inpatient and Outpatient Services. This includes writing clinical justification for admission and continued stay criteria based on clinical documentation in the patient record.  The UR Appeals Specialist will accurately report the appeals status to the Corporate Director of UR.  The UR Appeals Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.

• Oversees the appeals process for all denied claims on assigned caseload.
• Reviews the medical record to identify clinical criteria for an appeal completion and submission.
• Maintains an active involvement and awareness of all denials on their caseload to include appeals status
• Oversees the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals.
• Maintains logs of all denials along with updated status of same.
• Other Duties as assigned

Job Requirements:

• Bachelors Degree in Nursing, Social Work, or related field preferred
• 2 yrs exp in healthcare setting writing clinical or medical necessity appeals.
• LPN, RN, LSW, LPC are applicable licenses for this role. 

Perks at Work

Healthcare:

• Medical Packages with Rx – 3 Choices
• Flexible Spending Accounts (FSA)
• Dependent Day Care Spending Accounts
• Health Spending Accounts (HSA) with a company match
• Dental Care Program – 2 choices
• Vision Plan
• Life Insurance Options
• Accidental Insurances
• Paid Time Off + Paid Holidays
• Employee Assistance Programs
• 401k with a Company Match

Education + Leadership Development

• Up to $15,000 in Tuition Reimbursements
• Student Loan Forgiveness Programs

Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.