Utilization Review Specialist-FT
Utilization Review Specialist-FT
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
ESSENTIAL FUNCTIONS:
- Monitor utilization of services and optimize reimbursement for the facility while monitoring the use of the patients provider benefits for their specific needs.
- Responsible for conducting concurrent and discharge reviews for patients admitted to our inpatient behavioral health facility.
- Record all communication with Managed Care Organizations in accounting system.
- Educates members of the treatment team on documentation standards.
- Works closely with the physician social worker and nurses to coordinate treatment and to communicate issues regarding discharge planning length of stay and payer issues.
- Reports all denials to Director of UR immediately and facilitates peer review calls between facility and external organizations.
- Completes appeals for denied days and retrospective authorization requests when necessary.
- Completes insurance authorizations and concurrent reviews for IOP.
- Necessary skills include: pattern recognition independence critical thinking time efficiency organizational skills attention to detail knowledge of psychiatric medications ability to work with all levels of leadership customer service.
LICENSES:
- Preferred Licensure: LPN RN LSW Licensed Chemical Dependency Counselor Chemical Dependency Counselor Assistant as required within the state where the facility provides services.
Will consider a nonlicensed individual with strong behavioral health or insurance coordination background.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
