Employment Opportunities

We’re always looking for qualified candidates to join our team!

Utilization Review Specialist

Open

Position Description

We are currently looking for a Utilization Review Specialist to advocate for patient care for substance abuse and mental health treatment facilities by obtaining insurance authorizations for treatment and conducting concurrent reviews for continued care.

Responsibilities

• Obtain treatment authorizations from health insurance companies
• Maintain accurate and timely documentation

• Develop collaborative partnership relationships with insurance care managers to provide clients with expeditious delivery of service.
• Develop collaborative partnership relationships with health care providers and support staff through frequent communication and interaction.
• Function as a member of the Utilization Review Team to ensure that all daily responsibilities are met.
• Respond to insurance denials through the appeals process when appropriate.
• File retrospective reviews as needed.
• Participate in continuing professional education.
• Perform other duties as assigned or required.

Critical Competencies

• Demonstrate ability to independently identify and define potential and/or current issues of concern, collect and analyse data, establish facts, draw valid conclusions and exercise discretion and sound judgment.

• Demonstrate written and oral communication skills to formulate business correspondence and convey complex medical and behavioral health information.

Qualifications

• Knowledge of medical and behavioral health terminology, physiology, concepts of disease and treatment methodologies.
• Knowledge in reviewing medical and behavioral health records for medical necessity.
• Skill in operating a personal computer utilizing a variety of software applications a must.
• Organized and able to meet deadlines consistently.
• Excellent customer service skills.
• Current or former LPC, LCSW, RN licensure preferred.
• Strong knowledge base surrounding substance abuse and mental health conditions and Treatment is a must.