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.

Apply Now!

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