Behavioral Health Utilization Review Specialist

17 hours ago


Boonton, New Jersey, United States St. Clare's - Boonton Full time
Overview:

At St. Clare's Health, we strive to deliver exceptional care to our patients and communities. As a Behavioral Health Utilization Review Specialist, you will play a vital role in ensuring the quality and resource management of our inpatient behavioral health units.

Responsibilities include contacting external case managers and managed care organizations for pre-authorization, concurrent reviews, and appeals/denials management. You will also assist the treatment planning team in understanding insurance requirements and complete UR audits for billing compliance.

The ideal candidate will possess a Bachelor's degree in Social Work, Psychology, or a related field, with knowledge of DSM 5 diagnosis and medical necessity criteria for behavioral health levels of care. A Master's degree and one year of experience in direct care mental health, case management, discharge planning, or nursing management are preferred.

We are an equal employment opportunity employer and prohibit discrimination against any applicant or employee based on protected categories.

Responsibilities:

  • Quality and resource management of inpatient behavioral health units
  • Contacting external case managers and managed care organizations
  • Assisting treatment planning team with insurance requirements
  • Completing UR audits for billing compliance

Qualifications:

  • Bachelor's degree in Social Work, Psychology, or related field
  • Knowledge of DSM 5 diagnosis and medical necessity criteria
  • Preferred: Master's degree and one year of experience in direct care mental health


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