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Utilization Review Specialist
3 months ago
We are a psychiatric healthcare system, dedicated to providing mental healthcare for all, with seven locations in the Minneapolis/St. Paul metro area, and two additional sites located in Rochester and Mankato. With a robust benefits package, career advancement opportunities, and great workplace culture, we value our employees and the work they do each day for our patients and families. Our services span the full continuum of care for patients, with a variety of roles and opportunities for job-seekers looking for more than a job, but a place where you can grow in your career.
ResponsibilitiesThe Utilization Review Specialist acts as a liaison between the clinical treatment team and third-party payers to promote appropriate treatment for psychiatric illness and any other prescribed needs.
Responsibilities and Accountabilities:
- Obtain Medicaid behavioral health authorization upon discharge from higher levels of care
- Review denial of stay with UR Manager and assigned clinical treatment team as needed
- Facilitates appropriate action upon denial
- Maintains current level of knowledge on Medicaid authorization requirements
- Tracks each patient's course of treatment through inpatient and partial hospitalization programs for required clinical assessments and documentation
- Educates UR Team with Medicaid requirements for higher levels of care
- Oriented and educated in gender, cultural differences and in age-appropriate care for Utilization Review
- Bachelor's degree required
- Previous Utilization Review experience highly preferred
- Must be proficient in using Microsoft Office Suite and possess aptitude to learn and work in other applications, as needed.
PrairieCare is a psychiatric healthcare system experiencing rapid growth in the Twin Cities and southern Minnesota. With multiple sites across the metro, including locations in Rochester and Mankato, PrairieCare has quickly grown to become one of Minnesota's largest providers of mental health services to children, adolescents, adults, and their families.
PrairieCare does not discriminate against any person based on race, color, national origin, disability, or age in admissions, treatment, or participation in its programs, services, activities, or employment. PrairieCare is an Affirmative Action Employer/Equal Opportunity Employer supporting Veterans, Disabled, and other protected individuals and is committed to a diverse workforce. Offers of employment from PrairieCare are conditional and contingent upon successful clearance of all background studies.
PrairieCare is committed to ensuring equal employment opportunity, including providing reasonable accommodations to individuals with a disability. Applicants with a physical or mental disability who require a reasonable accommodation for any part of the application or hiring process please email hr@prairie-care.com for assistance.
Offers of employment from PrairieCare are conditional and contingent upon successful clearance of all background studies.
PrairieCare does not discriminate against any person on the basis of race, color, national origin, disability or age in admissions, treatment or participation in its programs, services, adolescents and their families. PrairieCare is an Affirmative Action Employer/Equal Opportunity Employer Offers of employment from PrairieCare are conditional and contingent upon successful clearance of all background studies.
