UR Specialist Non-Licensed

Personal Enrichment Through Mental Health Services Inc•Pinellas Park, FL

About The Position

The Emergency Services (ES) Utilization Review Specialist is responsible for conducting timely and accurate reviews of incoming admissions. Working in the intake phase of the client care process, this specialist reviews referral documentation to ensure alignment with established utilization criteria. The role involves close collaboration with admitting staff, and insurance providers to facilitate authorization for services and prevent unnecessary delays in care. The ES utilization review specialist ensures compliance with agency policies, regulatory requirements, and payer guidelines, playing a critical role in optimizing patient flow and resource utilization from the point of entry.

Requirements

Bachelor's degree in behavioral health or related field preferred or high school diploma and experience in utilization management, prior authorizations and working with insurance companies is required.
Knowledge of basic medical terminology.
Basic computer skills to include Microsoft Office products as well the ability to learn other software programs such as AVATAR.
Ability to communicate orally and in writing.
Ability to hear and see in emergency situations.
Must be able to pass NAPPI training and safely be able to physically handle potentially aggressive situations.
Demonstrates ability to operate basic office equipment accurately, including fax, telephone system, laptop/tablet, and copier/scanner.
Eligibility through a Level II background screening with AHCA and DCF (https://info.flclearinghouse.com [https://info.flclearinghouse.com/]_

Responsibilities

Responsible for utilization functions including verifying insurance benefits and eligibility for each client.
Completing precertification within a timely manner.
Tracking authorizations and completing concurrent reviews
Submitting discharges within a timely manner
Submitting appeals to insurance companies
Maintains accurate documentation to reflect all contacts made.
Needs to be able to utilize. Microsoft Word, Excel, Outlook, Medifax, Avatar, and external portals
Responsible for assisting with phones in Access Center and directing them to the appropriate department or person.
Entering referrals made from local hospitals and distributing to the nurses for review.
Documents in iCarol each phone call and identifying information
Tracks census information internally and externally at beginning and end of shift
Helps Emergency Services prepare charts, completes pre-certifications, and assists with taking clients to the restroom, obtaining client vitals, COVID-19 testing and screening, and performing body examinations and inventory as needed.
Show’s competency in all assigned job tasks on the unit, recovery room or inventory room. Seeks training from the lead Emergency Services staff when needed.
Develops and maintains competency in NAPPI, CPR/First Aid training, HIV/AIDS, Infection Control, annual DCF trainings, safety procedures and relevant Baker Act/Marchman Act facilitation of unit scheduled activities in a timely manner.