Utilization Review Specialist

2 weeks ago

Miami, Florida, United States Monte Nido Full time
Job Title: Utilization Review Clinician

We are seeking a highly skilled Utilization Review Clinician to join our team at Monte Nido. As a Utilization Review Clinician, you will play a critical role in ensuring that our clients receive the necessary care and services to achieve their health goals.

Responsibilities:
  • Conduct daily administrative and professional support to ensure accurate and timely processing of claims
  • Collaborate with treatment team members and admissions staff to discuss services covered by clients' benefits and review clinical documentation
  • Engage in clinical rounds as an active treatment team member to provide payor needs for next review, guidance on level of care recommendations, and feedback on what will be needed for authorization of clinically indicated services
  • Support admissions and program treatment team members in understanding how payors determine medical necessity, documentation needs, auth process, and determination timeline
  • Communicate with revenue cycle management and contracting regarding billing/claims issues and status of single case agreements
  • Leverage understanding of medical necessity criteria and current behavioral health insurance landscape in verbal and written communications with payors to maximize clients' access to care and decrease peer to peer reviews
Requirements:
  • Master's degree in counseling, social work, or an MSW, LCSW, LICSW, LPC, LMHC, or bachelor's degree in nursing preferred
  • Licensed and currently registered in the state you are working preferred
  • A minimum of one year of experience in a clinic or inpatient setting and knowledge relating to utilization review methods, insurance authorizations, Medicare, Medicaid, and managed care preferred
About Monte Nido:

Monte Nido has been delivering treatment for eating disorders for over two decades. Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

We prioritize your success and well-being, providing competitive compensation, medical, dental, and vision insurance coverage, retirement, company-paid life insurance, AD&D, and short-term disability, employee assistance program, flexible spending account, health savings account, paid time off, professional development, and many more.

We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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