Utilization Review Specialist
New
A
Advanced Recovery SystemsBehavioral healthcare
Workable workplace: remote; Workable locations: United StatesFull-TimeMiddle
SalaryAt least 50,000 USD per year
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Job Details
- Experience
- Minimum of three years’ experience working in a psychiatric or chemical dependency setting; Minimum of three years’ Utilization Review experience preferred
- Required Skills
- Data entry
Requirements
- Bachelor’s degree in a health or behavioral health related field required; a graduate degree in a related field is preferred.
- Alternatively, a high school diploma or equivalent with a state license is preferred.
- Minimum of three years’ experience working in a psychiatric or chemical dependency setting.
- Minimum of three years’ Utilization Review experience preferred.
- State licensure preferred, including Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, or Licensed Mental Health Counselor.
- Proficiency in establishing and maintaining effective communication with managed care companies.
- Ability to align medical and counseling staff to support timely services at the appropriate level of care.
- Ability to organize, multitask, prioritize, and work under pressure.
Responsibilities
- Complete pre-authorizations, concurrent reviews, and internal utilization reviews.
- Consult with multidisciplinary treatment team members to gather information for concurrent reviews.
- Schedule peer-to-peer reviews and coordinate urgent or expedited appeals.
- Staff individual cases with physicians as needed.
- Use the Utilization Review Census Report daily.
- Make initial calls within 24 hours and follow-up calls every 24 hours.
- Enter data, manage records, assist with appeals, and complete detailed daily documentation.
- Coordinate with the Finance Department regarding client service authorizations.
- Communicate frequently with the treatment team.
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