CLINICAL UR SPECIALIST
About The Position
The Clinical Utilization Review (UR) Specialist is responsible for ensuring that clients receive appropriate care while optimizing the utilization of healthcare resources. This position involves evaluating medical necessity, ensuring compliance with insurance guidelines, and collaborating with healthcare providers to facilitate client care transitions. The Clinical UR Specialist will review client records, make determinations on the appropriateness of hospital admissions and continued stays, and ensure that clinical documentation supports billing processes. The role also involves communication with insurance companies and external review agencies to ensure proper reimbursement.
Requirements
- Bachelor's Degree required
- Minimum of 2 years of clinical experience working with behavioral health clients preferred.
- Utilization Management experience preferred
Nice To Haves
- in Human Services field preferred
Responsibilities
- Collaborate with other clinical team members in staffing, reviewing actual and proposed psychiatric care and services against review criteria.
- Collaborates with providers to influence appropriate utilization of resources and transitions from one level of care to the next.
- Ensure compliance with governmental and insurance carrier regulations, policies, and guidelines.
- Review client clinical records, evaluate diagnostic tests, and monitor client progress to ensure care aligns with established medical guidelines.
- Communicate with insurance companies to obtain pre-certifications, authorizations, and approvals for client treatments.
- Serves as a liaison between the hospital, clients, and payers to address utilization management issues and potential denials.
Benefits
- Comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs
- Competitive compensation
- Generous retirement offerings
- Programs that invest in your career development
- Premium pay such as shift differential, on-call
- Opportunity for annual increases based on performance
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
- Paid Leave Hours accrued as you work
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
