We’re always looking for qualified candidates to join our team!
Utilization Review Specialist
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.
- 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.
- 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.
- 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.