Utilization Review Specialist
New
C
Charlie HealthBehavioral Healthcare
Remote, United States. Please note that this role is not available to candidates in Alaska, Maine, Washington DC, New Jersey, California, New York, Massachusetts, Connecticut, Colorado, Washington State, Oregon, or Minnesota.Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 2+ years
- Required Skills
- Project ManagementHIPAA
Requirements
- High School Diploma
- 2+ years of experience in a utilization role within the utilization review field
- Google proficiency
- Strong interpersonal, relationship-building and listening skills
- Ability to energize, communicate, and build rapport at all levels
- Strong project management skills
- Experience advising, presenting to, and persuading senior corporate personnel
- Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
- Familiarity with InterQual, MCG, or similar clinical guidelines
- Strong analytical, communication, and documentation skills
- Proficiency with electronic medical records (EMR) and utilization management systems
- Understanding of HIPAA and patient confidentiality requirements
Responsibilities
- Oversees all functions of a virtual IOP caseload
- Collaborates at a high level to problem solve on complex cases with Manager
- Completes pre-certs and authorizations for virtual IOP clients in a timely manner
- Follows up on all outstanding authorizations and reports all barriers to Manager
- Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge
- Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
- Delivers training to clinical teams for high quality documentation standardization
- Participate in denial management, appeals, and peer-to-peer review processes
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