Utilization Review Specialist - Mental Health/Behavioral Health
New
P
Pro Med Healthcare ServicesMental Health
Florida, United StatesContractMiddle
SalaryAt least 28 USD per hour
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Job Details
- Experience
- 2 years of previous experience in utilization review or insurance authorization preferred.
- Required Skills
- Microsoft Office SuiteEHR
Requirements
- Bachelor’s degree in Mental Health, Social Work, Psychology, or related field (or equivalent experience).
- 2 years of previous experience in utilization review or insurance authorization preferred.
- Strong knowledge of medical necessity criteria (e.g., ASAM, LOCUS, InterQual).
- Excellent communication, organizational, and time management skills.
- Proficiency in electronic health records.
- Proficiency in Microsoft Office Suite.
Responsibilities
- Review patient records to verify medical necessity and appropriateness of services.
- Conduct initial and concurrent reviews with insurance companies to obtain authorizations.
- Prepare and submit clinical documentation for continued stay requests.
- Track authorization status and maintain accurate documentation in the medical record.
- Communicate effectively with clinical teams to obtain required information.
- Assist with denial management and appeals as needed.
- Ensure compliance with state, federal, and accreditation requirements (e.g., CARF, AHCA, DCF, etc.).
- Maintain confidentiality of all patient and organizational information.
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