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Utilization Review Specialist
2 months ago
Walker Health Services is seeking a highly skilled Utilization Review Specialist to review patient admissions and clinical information for medical necessity and compliance with utilization review guidelines.
Key Responsibilities:
- Review patient admission and clinical information to ensure medical necessity and compliance with state-specific utilization review guidelines.
- Obtain initial and continuing authorization for treatment services.
- Manage authorization denials, including referrals for peer reviews.
- Advocate on behalf of patients to ensure the maximum length of stay at the appropriate level of care.
- Interact with insurance companies in a respectful and professional manner, adhering to policies and procedures.
- Document and record all necessary information related to patient care and authorization processes.
- Monitor and track new and ongoing authorization cases.
- Collaborate with clinical staff to ensure that necessary information is obtained and timely reviews are performed.
- Assist the treatment team in understanding payer requirements for admission, continued stay, and discharge planning.
- Participate in team meetings and case conference reviews.
- Maintain confidentiality of patient information in compliance with HIPAA regulations.
Requirements:
- 3-5 years of experience in Substance Abuse and/or Mental Health.
- Understanding of mental and behavioral health treatment services.
- Understanding of insurance benefits and coverages.
- Excellent attention to detail to ensure all necessary information is captured and properly documented.
- Ability to work independently and within a team environment.
- Ability to multi-task, prioritize, and meet expected deadlines.
- Strong computer skills, including proficiency with Word, Excel, and billing software.
- Superior written and oral communication skills.
Additional Information:
This job description is intended to provide a general overview of the responsibilities and requirements for the role. The employee may be required to perform other related duties as necessary to meet the organization's ongoing needs.
