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Healthcare Utilization Management Specialist

2 months ago

Delray Beach, Florida, United States Staffosaurus Full time
About the Role

At Staffosaurus, we are seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare management team, you will play a critical role in ensuring that our clients receive the highest level of care and reimbursement.

Key Responsibilities
  • Perform utilization review to ensure appropriate reimbursement by third-party payers.
  • Manage concurrent reviews for multiple locations and levels of care.
  • Process denials and appeals in a timely and efficient manner.
  • Coordinate with hospital and insurance doctors to obtain preauthorization for admissions and continued stays.
  • Communicate preauthorization outcomes and follow-up instructions to relevant administrative and clinical staff.
  • Document activity in billing and utilization review software and prepare reports for meetings and management review.
  • Organize and file documents for ease of access in approved locations.
  • Assist in compiling information for data analysis relating to preauthorization and reimbursement.
  • Maintain patient confidentiality in accordance with state and federal law.
  • Participate in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
Requirements
  • Master's degree from an accredited college or university in social work, mental health, nursing, or related field.
  • Knowledge of behavioral health systems and utilization management.
  • Two years of UR experience in a hospital or healthcare insurance setting.
  • LMSW, LMHC, LPC, or other healthcare-related licensure preferred.
Benefits
  • Competitive pay and benefits package.
  • Opportunities for professional growth and development.
  • Positive and fulfilling work environment.