Utilization Review Specialist
About The Position
The Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. This role analyzes patient records to determine the legitimacy of admission, treatment, and length of stay, and interfaces with managed care organizations, external reviewers, and other payers. The specialist advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric, or emotional disorders to manage care providers for necessary treatment. The role involves contacting external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assisting the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.
Requirements
- Bachelor’s degree required.
- CPR certification preferred.
- Crisis Prevention Training (CPI) preferred.
Nice To Haves
- Master’s degree preferred.
- Previous utilization review experience in a psychiatric healthcare facility preferred.
- Current unencumbered clinical license preferred.
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
- Flexible-spending and health-savings accounts
- Competitive paid time off
- Life insurance
- Accident insurance
- Critical-injury insurance
- Short- and long-term disability
- Identity theft coverage
- Tuition reimbursement
- Loan assistance
- 401(k) matching
- Employee assistance program including mental, physical, and financial wellness
- Professional development and growth opportunities
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
