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Utilization Review Specialist

2 months ago

Wellington, United States Penrod Enterprises Part time $28 - $32
Job DescriptionJob Description

We are looking for a Utilization Review Specialist who can support our busy department. Our ideal candidate has experience working as a nurse or clinician in an inpatient or outpatient behavioral health or substance use disorder facility setting and can provide excellent customer service to facilities while conducting utilization reviews of insurance authorizations. We are looking for skilled professionals who are passionate about their work, and can help us achieve our goals of providing high-quality patient care.

Responsibilities:

  • Facilitate phone calls to insurance companies to request authorizations on behalf of healthcare providers
  • Complete concurrent reviews for continued stays
  • Conduct "live" phone reviews and new admissions with insurance companies
  • Coordinate and when appropriate complete peer reviews
  • Submit electronic authorization requests via fax, email. and insurance portals
  • Communicate with facility staff regarding upcoming reviews and approvals
  • Identify themes and trends in the medical record work and make recommendations for improvement.
  • Ensure that compliance with medical/clinical standards are maintained by the treating clinicians

 

Job Type: Part-time

Pay: $28.00 - $33.00 per hour

Expected hours: 20 per week

Schedule:

  • Monday to Friday

Experience:

  • Utilization review: 3 years (Required)
  • RN/Masters Level (or higher) clinician preferred but will consider non-licensed in lieu of additional work experience

Work Location: Remote

Company DescriptionOur company specializes in mental health and substance use disorder revenue cycle management.Company DescriptionOur company specializes in mental health and substance use disorder revenue cycle management.