Utilization Review Specialist
About The Position
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers, and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.
Requirements
- Bachelor’s degree required. Master’s degree preferred.
- Previous utilization review experience in a psychiatric healthcare facility preferred.
- License: Current unencumbered clinical license preferred.
- CPR certification and Crisis Prevention Training (CPI) preferred.
- May be required to work flexible hours and overtime.
Responsibilities
- facilitates clinical reviews on all patient admissions and continued stays
- analyzes patient records to determine legitimacy of admission, treatment, and length of stay
- interfaces with managed care organizations, external reviewers, and other payers
- advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment
- contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay
- assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning
Benefits
- Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts
- Competitive paid time off
- Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
- Tuition reimbursement, loan assistance, and 401(k) matching
- Employee assistance program including mental, physical, and financial wellness
- Professional development and growth opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
101-250 employees
