UR Specialist
3 weeks ago
Kingston, United States
Moriah Behavioral Health
Full time
Job TypeFull-time
Description
SUMMARY: The UR Specialist is responsible for using their clinical knowledge and/or nursing experience, the review of preauthorization and concurrent review requests for all levels of care. Must collaborate with clinical and admissions staff to gather necessary information for thorough pre-authorizations and concurrent reviews.
DUTIES AND RESPONSIBILITIES:
- Using clinical knowledge and/or nursing experience, the Utilization Specialist reviews provider requests for inpatient and outpatient services, works closely with providers to collect all information necessary to perform a thorough medical necessity review.
- Completes Peer reviews as necessary and or assisting in Peer reviews and Live Appeals with the appropriate person.
- Participates in treatment team meetings, review client charts, complete requests for Single Case Agreements (SCA's) or Letters of Agreement (LOA's) with out of network insurance providers.
- Write appeals, carry a caseload, and communicate interdepartmentally regarding insurance denials.
- The role requires advanced understanding of clinical terminology, the ability to build rapport, and a strong grasp of medical necessity criteria.
Requirements
QUALIFICATIONS:
- Bachelor's in business administration or healthcare preferred
- Previous utilization review experience in healthcare related fields with customer service experience
Benefits:
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Salary Description
45,000.00
